Echocardiographic determination of pulmonary arterial capacitance.
Echocardiographic determination of pulmonary arterial capacitance.
复制标题
超声心动图测定肺动脉电容。
DOI：
10.1007/s10554-019-01595-9
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Tison,GeoffreyH
中科院分区：
文献类型：
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作者：
Papolos,Alexander;Fan,Eugene;Wagle,RohanR;Foster,Elyse;Boyle,AndrewJ;Yeghiazarians,Yerem;MacGregor,JohnS;Grossman,William;Schiller,NelsonB;Ganz,Peter;Tison,GeoffreyH
越来越多的证据表明，肺动脉电容（PAC）是广泛的心血管疾病（包括肺动脉高压和心力衰竭）临床结局的最强血流动力学预测因子。我们假设右心室每搏输出量（RVOT VTI）与相关的动脉收缩压峰值（PASP）的比值可以作为PAC的可靠的无创替代指标。我们对同时接受经胸超声心动图和右心导管插入术（RHC）治疗各种临床适应症的患者进行了一项前瞻性研究。将超声心动图测量的RVOT VTI/PASP比值与RHC测量计算的PAC进行比较。相关系数和Bland-Altman分析比较了RVOT VTI/PASP比值与PAC。入组了45例受试者，38%为女性，平均年龄为54岁（SD 13岁）。转诊至RHC的原因最常见的是心脏移植后监测（40%），其次是心力衰竭（22%）和肺动脉高压（18%）。18%存在毛细血管前肺动脉高压，13%存在单纯毛细血管后肺动脉高压，29%存在毛细血管前和毛细血管后肺动脉高压。大部分患者（78%）可测得RVOT VTI/PASP比值，Pearson相关分析显示PAC与RVOT VTI/PASP比值呈中强相关，r = 0.75（P < 0.001）。Bland-Altman分析表明，测量值之间具有良好的一致性，没有系统偏倚的迹象，标准化单位的平均差异为-0.133。在不同的患者人群和血流动力学特征中，我们验证了RVOT VTI/PASP比值是与PAC相关的可靠的非侵入性标志物。
A growing body of evidence has demonstrated that pulmonary arterial capacitance (PAC) is the strongest hemodynamic predictor of clinical outcomes across a wide spectrum of cardiovascular disease, including pulmonary hypertension and heart failure. We hypothesized that a ratio of right ventricular stroke volume (RVOT VTI) to the associated peak arterial systolic pressure (PASP) could function as a reliable non-invasive surrogate for PAC. We performed a prospective study of patients undergoing simultaneous transthoracic echocardiography and right heart catheterization (RHC) for various clinical indications. Measurements of the RVOT VTI/PASP ratio from echocardiographic measurements were compared against PAC calculated from RHC measurements. Correlation coefficients and Bland–Altman analysis compared the RVOT VTI/PASP ratio with PAC. Forty-five subjects were enrolled, 38% were female and mean age was 54 years (SD 13 years). The reason for referral to RHC was most commonly post-heart transplant surveillance (40%), followed by heart failure (22%), and pulmonary hypertension (18%). Pre-capillary pulmonary hypertension was present in 18%, isolated post-capillary pulmonary hypertension was present in 13%, and combined pre-and post-capillary pulmonary hypertension was present in 29%. The RVOT VTI/PASP ratio was obtainable in the majority of patients (78%), and Pearson′s correlation demonstrated moderately-strong association between PAC and the RVOT VTI/PASP ratio, r = 0.75 (P < 0.001). Bland–Altman analysis demonstrated good agreement between measurements without suggestion of systematic bias and a mean difference in standardized units of − 0.133. In a diverse population of patients and hemodynamic profiles, we validated that the ratio of RVOT VTI/PASP to be a reliably-obtained non-invasive marker associated with PAC.