QUANTITATIVE ASSESSMENT OF PULMONARY-HYPERTENSION IN PATIENTS WITH TRICUSPID REGURGITATION USING CONTINUOUS WAVE DOPPLER ULTRASOUND
QUANTITATIVE ASSESSMENT OF PULMONARY-HYPERTENSION IN PATIENTS WITH TRICUSPID REGURGITATION USING CONTINUOUS WAVE DOPPLER ULTRASOUND
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DOI：
10.1016/s0735-1097(85)80172-8
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发表时间：
1985-01-01
影响因子：
24
通讯作者：
GOLDBERG, E
中科院分区：
文献类型：
--
作者：
BERGER, M;HAIMOWITZ, A;GOLDBERG, E
本文对69例因各种心肺功能障碍行床旁右心导管检查的患者进行了多普勒超声检查。根据血流动力学结果将患者分为2组。I组包括20例肺动脉收缩压< 35 mm Hg的患者，II组包括49例肺动脉收缩压≥ 35 mm Hg的患者。I组20例中2例检出三尖瓣返流，II组49例中39例检出三尖瓣返流（P < 0.001）。27例肺动脉收缩压> 50 mm Hg的患者中有26例有三尖瓣返流的多普勒证据。在三尖瓣返流患者中，使用连续波多普勒超声测量返流射流的速度，并应用Bernoulli方程计算右心室和右心房之间的峰值压力梯度。多普勒梯度与心导管测量的肺动脉收缩压之间存在密切的相关性（r = 0.97，估计的标准误差= 4.9 mm Hg）。没有必要在临床上估计右心房压力并将其添加到多普勒确定的右心室-右心房压力梯度中以获得准确的结果。显然，在大部分肺动脉高压患者中，特别是当肺动脉压超过50 mm Hg时，可以通过多普勒超声识别三尖瓣返流。计算这些患者的右心室到右心房的压力梯度可以准确无创地估计肺动脉收缩压。
Doppler ultrasound examination was performed in 69 patients with a variety of cardiopulmonary disorders who were undergoing bedside right heart catheterization. Patients were classified into 2 groups on the basis of hemodynamic findings. Group I consisted of 20 patients whose pulmonary artery systolic pressure was < 35 mm Hg and Group II consisted of 49 patients whose pulmonary artery systolic pressure was 35 mm Hg or greater. Tricuspid regurgitation was detected by Doppler ultrasound in 2 of 20 Group I patients and 39 of 49 Group II patients (P < 0.001). Twenty-six of 27 patients with pulmonary artery systolic pressure > 50 mm Hg had Doppler evidence of tricuspid regurgitation. In patients with tricuspid regurgitation, continuous wave Doppler ultrasound was used to measure the velocity of the regurgitant jet, and by applying the Bernoulli equation, the peak pressure gradient between the right ventricle and right atrium was calculated. There was a close correlation between the Doppler gradient and the pulmonary artery systolic pressure measured by cardiac catheterization (r = 0.97, standard error of the estimate = 4.9 mm Hg). Estimating the right atrial pressure clinically and adding it to the Doppler-determined right ventricular to right atrial pressure gradient was not necessary to achieve accurate results. Apparently, tricuspid regurgitation can be identified by Doppler ultrasound in a large proportion of patients with pulmonary hypertension, especially when the pulmonary artery pressure exceeds 50 mm Hg. Calculation of the right ventricular to right atrial pressure gradient in these patients provides an accurate noninvasive estimate of pulmonary artery systolic pressure.