Derivation of Mean Pulmonary Artery Pressure from Noninvasive Parameters
Derivation of Mean Pulmonary Artery Pressure from Noninvasive Parameters
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DOI：
10.1016/j.echo.2013.01.006
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发表时间：
2013-05-01
影响因子：
6.5
通讯作者：
Sorajja, Paul
中科院分区：
文献类型：
--
作者：
Steckelberg, Rachel C.;Tseng, Andrew S.;Sorajja, Paul
背景：肺动脉压的评估对于肺动脉高压患者的诊断和治疗具有重要意义。平均肺动脉压（MPAP）已用于当前肺动脉高压的定义中。然而，多普勒超声心动图有创推导可提供肺动脉收缩压峰值 (PASP)。本研究的目的是推导出一种根据 PASP 预测 MPAP 的方法。方法：检查了 307 名接受右心导管插入术的患者的有创血流动力学压力。使用简单回归技术来确定衍生队列 (n = 198) 和验证样本 (n = 109) 中 MPAP 和 PASP 之间的关系。进行 Bland-Altman 分析以检查 MPAP 的预测值与观测值。结果：插管时的 MPAP 和 PASP 在一定压力范围内密切相关（R-2 = 0.89，n = 198；SE，4.04；P < .0001）。推导队列中 MPAP 与 PASP 的关系（MPAP = 0.61 x PASP + 1.95 mm Hg）在测试样本中得到验证，预测与观察到的 MPAP 的 R-2 值为 0.94（SE，2.87；P < .0001）。预测的 MPAP 与观察到的 MPAP 的关系在不同程度的压力升高以及不同的肺动脉高压病因中是恒定的。将方程应用于多普勒肺动脉压力，超声心动图预测的 MPAP 与有创测量的 MPAP 之间存在极好的相关性 (R-2 = 0.78，P < .0001)。结论：对于不同病因的肺动脉高压，可以在较宽的压力范围内根据 PASP 准确预测 MPAP。这一发现可能有助于无创地定义 MPAP。
Background: The assessment of pulmonary pressure is important for the diagnosis and management of patients with pulmonary hypertension. Mean pulmonary artery pressure (MPAP) has been used in the current definition of pulmonary hypertension. However, invasive derivation by Doppler echocardiography provides the peak pulmonary artery systolic pressure (PASP). The aim of this study was to derive a method to predict MPAP from PASP.Methods: Invasive hemodynamic pressures in 307 patients who underwent right heart catheterization were examined. Simple regression techniques were used to determine the relationship between MPAP and PASP in a derivation cohort (n = 198) and a validation sample (n = 109). Bland-Altman analysis was performed to examine predicted versus observed values of MPAP.Results: MPAP and PASP at catheterization were strongly related over a range of pressures (R-2 = 0.89, n = 198; SE, 4.04; P < .0001). The relation of MPAP to PASP in the derivation cohort (MPAP = 0.61 x PASP + 1.95 mm Hg) was validated in the test sample, with an R-2 value of 0.94 for predicted versus observed MPAP (SE, 2.87; P < .0001). The relationship of predicted versus observed MPAP was constant across different degrees of pressure elevation, as well as different etiologies of pulmonary hypertension. Applying the equation to Doppler-derived pulmonary pressures, there was excellent correlation of predicted MPAP from echocardiography and invasively measured MPAP (R-2 = 0.78, P < .0001).Conclusions: MPAP can be accurately predicted from PASP over a wide pressure range for different etiologies of pulmonary hypertension. This finding may help define MPAP noninvasively.