Non-invasive estimation of pulmonary vascular resistance in patients of pulmonary hypertension in congenital heart disease with unobstructed pulmonary flow.
Non-invasive estimation of pulmonary vascular resistance in patients of pulmonary hypertension in congenital heart disease with unobstructed pulmonary flow.
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DOI：
10.4103/0974-2069.132475
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发表时间：
2014-05
影响因子：
0.7
通讯作者：
Samanta A
中科院分区：
文献类型：
--
作者：
Pande A;Sarkar A;Ahmed I;Naveen Chandra G;Patil SK;Kundu CK;Arora R;Samanta A
肺血管阻力（PVR）是评价先天性心脏病合并肺动脉高压患者治疗效果和选择治疗方案的重要指标。本研究计划评价无创超声心动图参数，以评估肺血管阻力。这项前瞻性观察性研究纳入了44例在我们机构的心脏病和儿科心脏病病房住院的患者，这些患者接受了诊断性或术前基于导管的肺动脉压和PVR评价。详细的超声心动图评价包括三尖瓣返流速度（TRV）和右室流出道速度时间积分（VTIRVOT）。这些参数与基于导管的PVR测量值相关。TRV/VTIRVOT比值与导管插入时测量的PVR（PVRcath）相关性良好（r = 0.896，95%置信区间[CI] 0.816至0.9423，P < 0.001）。使用Bland-Altman分析，多普勒数据得出的PVR测量值与导管检查估计的PVR的一致性范围令人满意。当PVR为6个Wood单位（WU）时，TRV/VTIRVOT值为0.14，敏感性为96.67%，特异性为92.86%（曲线下面积0.963，95%置信区间0.858 - 0.997），对于PVR为8 WU，TRV/VTIRVOT值为0.17时，敏感性为79.17%，特异性为95%（曲线下面积0. 0.923，95%置信区间0.801至0.982）。TRV/VTIRVOT比值是一个简单、无创的指标，可用于评估PVR。
Pulmonary vascular resistance (PVR) is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease accompanied by pulmonary arterial hypertension. The present study was planned to evaluate non-invasive echocardiographic parameters to assess pulmonary vascular resistance. This prospective observational study included 44 patients admitted in the cardiology and pediatric cardiology ward of our institution for diagnostic or pre-operative catheter based evaluation of pulmonary arterial pressure and PVR. Detailed echocardiographic evaluation was carried out including tricuspid regurgitation velocity (TRV) and velocity time integral of the right-ventricular outflow tract (VTIRVOT). These parameters were correlated with catheter-based measurements of PVR. The TRV/VTIRVOT ratio correlated well with PVR measured at catheterization (PVRcath) (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001). Using the Bland-Altman analysis, PVR measurements derived from Doppler data showed satisfactory limits of agreement with catheterization estimated PVR. For a PVR of 6 Wood units (WU), a TRV/VTIRVOT value of 0.14 provided a sensitivity of 96.67% and a specificity of 92.86% (area under the curve 0.963, 95% confidence interval 0.858 to 0.997) and for PVR of 8 WU a TRV/VTIRVOT value of 0.17 provided a sensitivity of 79.17% and a specificity of 95% (area under the curve 0. 0.923, 95% confidence interval 0.801 to 0.982). Doppler-derived ratio of TRV/VTIRVOT is a simple, non-invasive index, which can be used to estimate PVR.