Noninvasive model including right ventricular speckle tracking for the evaluation of pulmonary hypertension
Noninvasive model including right ventricular speckle tracking for the evaluation of pulmonary hypertension
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DOI：
10.4330/wjc.v8.i8.472
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发表时间：
2016-08-26
影响因子：
1.9
通讯作者：
Hammerstingl, Christoph
中科院分区：
文献类型：
--
作者：
Mahran, Yossra;Schueler, Robert;Hammerstingl, Christoph
目的探讨经胸超声心动图（TTE）对毛细血管前肺动脉高压（PH）的诊断价值。所有患者均接受标准化TTE，包括RV ST分析。根据随后的TTE测量结果，评估是否存在PH：根据4Ch，通过Ehrson法则计算左心室射血分数（LVEF）。用连续波多普勒三尖瓣收缩期血流速度评估收缩期肺动脉压（sPAP），并将升高>= 30 mmHg作为RA压力的替代参数。同时升高的PCWP被认为是区分毛细血管前和毛细血管后形式的PH的一种手段。当E/e'比> 12时，作为LV舒张压的替代，PCWP被认为是升高的。采用TDI模式测量二尖瓣环侧部和间隔部的收缩期和舒张期血流速度，测量E/e'比值。然后将结果与二尖瓣流入量的常规测量值取平均值。此外，还对6 min步行距离（6 MWD）功能测试、ECG RV应激体征、NT pro-BNP和其他实验室检查值进行了评估。TTE显示E/e'比值有显著性差异（毛细血管前PH：12.3 +/- 4.4，毛细血管后PH：17.3 +/- 10.3，无PH：12.1 +/- 4.5，P = 0.02），LV容积（ESV：25.0 ± 15.0 mL，49.9 ± 29.5 mL，32.2 ± 13.6 mL，P = 0.027; EDV：73.6 ± 24.0 mL，110.6 ± 31.8 mL，87.8 ± 33.0 mL，P = 0.021）和收缩期肺动脉压（sPAP：61.2 +/- 22.3 mmHg，53.6 +/- 20.1 mmHg，31.2 +/- 24.6 mmHg，P = 0.001）。STRV分析显示心尖RV纵向应变存在显著差异（RVAS：-7.5% +/-5.6%，-13.3% +/-4.3%，-14.3% +/-6.3%，P = 0.03）。毛细血管后PH患者的NT proBNP更高（4677.0 +/- 7764.1 pg/mL，毛细血管前PH：1980.3 +/- 3432.1 pg/mL，无PH：367.5 +/- 420.4 pg/mL，P = 0.03）。毛细血管前PH患者更常出现ECG RV应激体征（P = 0.001）。受试者工作特征曲线分析显示，RVAS（截止值<-6.5%，AUC 0.91，P < 0.001）、sPAP（截止值> 33 mmHg，AUC 0.86，P < 0.001）和ECG RV应激体征（AUC 0.83，P < 0.001）的曲线下面积（AUC）最显著。这些参数的组合检测毛细血管前PH的敏感性为82.8%，特异性为17.2%。结论非侵入性测量的组合允许对PH进行可行的评估，并且似乎有利于区分这种疾病的毛细血管前和毛细血管后形式。
AIMTo find parameters from transthorathic echocardiography (TTE) including speckle-tracking (ST) analysis of the right ventricle (RV) to identify precapillary pulmonary hypertension (PH).METHODSForty-four patients with suspected PH under-going right heart catheterization (RHC) were con-secutively included (mean age 63.1 +/- 14 years, 61% male gender). All patients underwent standardized TTE including ST analysis of the RV. Based on the subsequent TTE-derived measurements, the presence of PH was assessed: Left ventricular ejection fraction (LVEF) was calculated by Simpsons rule from 4Ch. Systolic pulmonary artery pressure (sPAP) was assessed with continuous wave Doppler of systolic tricuspid regurgitant velocity and regarded raised with values >= 30 mmHg as a surrogate parameter for RA pressure. A concomitantly elevated PCWP was considered a means to discriminate between the precapillary and postcapillary form of PH. PCWP was considered elevated when the E/e' ratio was > 12 as a surrogate for LV diastolic pressure. E/e' ratio was measured by gauging systolic and diastolic velocities of the lateral and septal mitral valve annulus using TDI mode. The results were then averaged with conventional measurement of mitral valve inflow. Furthermore, functional testing with six minutes walking distance (6MWD), ECG-RV stress signs, NT pro-BNP and other laboratory values were assessed.RESULTSPH was confirmed in 34 patients (precapillary PH, n = 15, postcapillary PH, n = 19). TTE showed significant differences in E/e' ratio (precapillary PH: 12.3 +/- 4.4, postcapillary PH: 17.3 +/- 10.3, no PH: 12.1 +/- 4.5, P = 0.02), LV volumes (ESV: 25.0 +/- 15.0 mL, 49.9 +/- 29.5 mL, 32.2 +/- 13.6 mL, P = 0.027; EDV: 73.6 +/- 24.0 mL, 110.6 +/- 31.8 mL, 87.8 +/- 33.0 mL, P = 0.021) and systolic pulmonary arterial pressure (sPAP: 61.2 +/- 22.3 mmHg, 53.6 +/- 20.1 mmHg, 31.2 +/- 24.6 mmHg, P = 0.001). STRV analysis showed significant differences for apical RV longitudinal strain (RVAS: -7.5% +/- 5.6%, -13.3% +/- 4.3%, -14.3% +/- 6.3%, P = 0.03). NT proBNP was higher in patients with postcapillary PH (4677.0 +/- 7764.1 pg/mL, precapillary PH: 1980.3 +/- 3432.1 pg/mL, no PH: 367.5 +/- 420.4 pg/mL, P = 0.03). Patients with precapillary PH presented significantly more often with ECG RV-stress signs (P = 0.001). Receiver operating characteristics curve analyses displayed the most significant area under the curve (AUC) for RVAS (cut-off < -6.5%, AUC 0.91, P < 0.001), sPAP (cut-off > 33 mmHg, AUC 0.86, P < 0.001) and ECG RV stress signs (AUC 0.83, P < 0.001). The combination of these parameters had a sensitivity of 82.8% and a specificity of 17.2% to detect precapillary PH.CONCLUSIONThe combination of non-invasive measurements allows feasible assessment of PH and seems beneficial for the differentiation between the pre-and postcapillary form of this disease.