Tissue Doppler imaging predicts adverse outcome in children with idiopathic pulmonary arterial hypertension.
Tissue Doppler imaging predicts adverse outcome in children with idiopathic pulmonary arterial hypertension.
复制标题
组织多普勒成像可预测特发性肺动脉高压儿童的不良后果。
DOI：
10.1016/j.jpeds.2012.05.050
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Saji,Tsutomu
中科院分区：
文献类型：
--
作者：
Takatsuki,Shinichi;Nakayama,Tomotaka;Jone,Pei-Ni;Wagner,BrandieD;Naoi,Kazuyuki;Ivy,DDunbar;Saji,Tsutomu
目的：评价组织多普勒成像（TDI）在评估特发性肺动脉高压（PAH）患儿疾病严重程度及预后价值中的临床应用价值。研究设计：对51例特发性PAH患儿（平均年龄11.6岁）的TDI速度（收缩心肌速度、舒张早期心肌舒张速度[Em]、与心房收缩相关的舒张晚期心肌速度）、脑利钠肽、纽约心脏协会（NYHA）功能分级和血流动力学进行前瞻性研究。51名具有可比人口统计学特征的健康儿童作为对照。结果：与对照组相比，PAH患者心房收缩比相关的Em、Em/舒张后期心肌速度以及二尖瓣环、中隔和三尖瓣环的收缩心肌速度均显著降低。三尖瓣Em与血浆脑利钠肽水平（r = - 0.60, P < .001）、右心室舒张末期压（r = - 0.79, P < .001）、平均肺动脉压（r = - 0.67, P < .001）呈显著负相关。三尖瓣Em在NYHA功能等级II与合并的III和IV之间有统计学差异（平均值和标准差分别为11.9±4.2 cm/s和8.2±3.6 cm/s, P = 0.002）。当三尖瓣Em≤8 cm/s时，累积无事件生存率显著降低（log-rank检验，P < .001）。结论：三尖瓣Em速度与NYHA功能等级作为疾病严重程度相关，可作为特发性PAH患儿的有用预后指标。本研究是评估TDI速度与相对较大的儿童PAH人群中期结果变量的初步报告。
OBJECTIVE: To evaluate the clinical utility of tissue Doppler imaging (TDI) in assessment of disease severity and prognostic value in children with idiopathic pulmonary arterial hypertension (PAH). STUDY DESIGN: A prospective study was performed to evaluate TDI velocities (systolic myocardial velocity, early diastolic myocardial relaxation velocity [Em], late diastolic myocardial velocity associated with atrial contraction), brain natriuretic peptide, New York Heart Association (NYHA) functional class, and hemodynamics in 51 children (mean age; 11.6 years) with idiopathic PAH. Fifty-one healthy children with comparable demographics served as controls. RESULTS: Em, Em/late diastolic myocardial velocity associated with atrial contraction ratio, and systolic myocardial velocity at mitral annulus, septum, and tricuspid annulus in PAH were significantly reduced compared with controls. Tricuspid Em had significant inverse correlations with plasma brain natriuretic peptide levels (r = −0.60, P < .001), right ventricular end-diastolic pressure (r = −0.79, P < .001), and mean pulmonary arterial pressure (r = −0.67, P < .001). Statistically significant differences were observed in tricuspid Em between NYHA functional class II vs combined III and IV (mean and SD; 11.9 ± 4.2 cm/s vs 8.2 ± 3.6 cm/s, respectively, P = .002). Cumulative event-free survival rate was significantly lower when tricuspid Em was ≤8 cm/s (log-rank test, P < .001) CONCLUSIONS: Tricuspid Em velocity correlated with NYHA functional class as disease severity and may serve as a useful prognostic marker in children with idiopathic PAH. The present study is the initial report to evaluate TDI velocities against midterm outcome variables in a relatively large pediatric PAH population.