A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension
A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension
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DOI：
10.1016/j.echo.2009.01.021
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发表时间：
2009-05-01
影响因子：
6.5
通讯作者：
Rosenthal, David
中科院分区：
文献类型：
--
作者：
Haddad, Francois;Zamanian, Roham;Rosenthal, David
背景资料：肺血管阻力（PVR）的测定对肺动脉高压（PAH）的诊断和治疗具有重要意义。本研究的主要目的是确定肺动脉收缩压（SPAP）的非侵入性指数，心率（HR）倍右心室流出道时间-速度积分（TVIRVOT）（SPAP/[HR x TVIRVOT]）是否提供了临床有用的估计PVR在PAH.Methods：多普勒超声心动图和右心导管检查进行了51例连续的PAH患者。然后使用回归和Bland-Altman分析将SPAP/（HR x TVIRVOT）比值与侵入性指数PVR（PVRI）相关。使用接收器工作特征曲线分析，生成多普勒方程的截止值以识别PVRI >= 15 Wood单位（WU）/m2的患者。结果：平均肺动脉压为52 ± 15 mm Hg，平均心脏指数为2.2 ± 0.6 L/min/m2，平均PVRI为20.5 ± 9.6 WU/m2。SPAP/（HR x TVIRVOT）比值与有创PVRI测量值相关性非常好（r=0.860; 95%置信区间，0.759-0.920）。0.076的临界值提供了良好平衡的敏感性（86%）和特异性（82%），以确定PVRI>15 WU/m2。结论：SPAP/（HR x TVIRVOT）是评价肺动脉高压患者肺静脉阻力指数的有效指标。（J Am Soc Echocardiogr 2009; 22：523-529.）
Background: The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVIRVOT) (SPAP/[HR x TVIRVOT]) provides clinically useful estimations of PVR in PAH.Methods: Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR x TVIRVOT) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI >= 15 Wood units (WU)/m(2).Results: The mean pulmonary arterial pressure was 52 +/- 15 mm Hg, the mean cardiac index was 2.2 +/- 0.6 L/min/m(2), and the mean PVRI was 20.5 +/- 9.6 WU/m(2). The ratio of SPAP/(HR x TVIRVOT) correlated very well with invasive PVRI measurements (r=0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI>15 WU/m(2). A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%.Conclusion: The novel index of SPAP/(HR x TVIRVOT) provides useful estimations of PVRI in patients with PAH. (J Am Soc Echocardiogr 2009; 22: 523-529.)