肺动态显像对瓣膜性心脏病合并肺动脉高压的临床价值

Evaluation of pulmonary hypertension using first-pass radionudide angiography in patients with valvular heart disease

目的 探讨核素肺动态显像对瓣膜性心脏病(简称瓣膜病)合并肺动脉高压(PH)的临床价值。方法 瓣膜病患者140例手术前均行右心导管、肺动态显像、超声心动图检查。按平均肺动脉压力(MPAP)水平分为4组,MPAP<20 mm Hg(1 mm Hg=0.133 kPa)为正常组,20 mm Hg<MPAP<30mm Hg为轻度升高组,30mm Hg≤MPAP<50 mm Hg为中度升高组,≥50mm Hg为重度升高组。对照组53例,均行肺动态显像,分为冠心病对照组(13例)及正常对照组(40例)。冠心病对照组均行右心导管检查。结果 ①冠心病对照组、正常对照组、瓣膜病各组肺动态显像测定的肺平衡时间(LET)分别为(16.88±5.12)、(15.89±4.69)、(18.56±3.04)、(25.37±5.89)、(37.69±6.25)及(61.33±10.14)s,冠心病对照组、正常对照组与瓣膜病MPAP正常组3组间差异无显著性(P均>0.05),瓣膜病各组间及对照组与MPAP轻度升高组、中度升高组、重度升高组间差异有显著性(P均<0.001)。②肺动态显像测定的LET与右心导管所测MPAP相关系数r为0.88,超声心动图估测的肺动脉压力与肺动脉收缩压r为0.64。③瓣膜病各组LET与MPAP的符合率分别为71％、78％、81％、100％。④以MPAP≥20mm Hg为标准LET测定肺动脉压力的灵敏度为85％,特异性79％,准确性83％。结论

Objective To evaluate pulmonary hypertension (PH) using first-pass radionuclide angiography in patients with valvular heart disease. Methods One hundred and forty patients (54 males, 86 females, average age of 44.75 ± 10.84) with valvular disease were included in this study. Swan-Ganz thermodilution cathe-terization, echocardiography and first-pass radionuclide angiography were perfonned on all patients before surgery. Patients were divided into four groups: pulmonary artery pressure (PAP) normal group [mean PAP (MPAP) < 20 mm Hg( 1mm Hg = 0.133 kPa) ]; PAP slightly risen group (20 mm Hg≤MPAP< 30 mm Hg); PAP moderately risen group (30 mm Hg≤MPAP< 50 mm Hg); PAP highly risen group (MPAP≥50 mm Hg). Thirteen subjects with coronary heart disease and 40 normal subjects (36 males, 17 females, average age of 46.30±11.19) were included as control group. First-pass radionuclide angiography was perfonned on these subjects, Swan-Ganz thermodilution catheteriation was performed on patients with coronary heart disease. Results ①Lung equilibrium time (LET) values by first-pass radionuclide angiography were (16.88±5.12), (15.89±4.69), (18.56 ± 3.04), (25.37±5.89), (37.69±6.25) and ( 61.33±10.14) s in coronary heart disease group, normal subject group and four valvular heart disease groups, respectively. The differences were significant among four valvular heart disease groups; and among control group, PAP slightly risen group, PAP moderately risen group, PAP highly risen group (P < 0.001).②Correlation coefficient between LET and MPAP from the afloat catheter manometer was 0.88 and between systolic PAP (SPAP) from echocardiography and SPAP from the afloat catheter manometer was 0.64. ③Agreement was 71% , 78%, 81% , 100% between LET and MPAP in four valvular heart disease groups, respectively. ④ Sensitivity, specificity and accuracy of PAP using LET measuring was 85%, 79% and 83%, respectively. Conclusion First-pass radionuclide angiography is an accurate and noninvasive method for evaluating pulmonary hypertension in valvular heart disease.