舒张末期右心室前壁厚度与舒张末期左心室后壁厚度比值对室间隔缺损患者肺动脉压评估的价值

The evaluation of patients with pulmonary hypertention of isolated congenital ventricular septal defect by a thickness ratio of right ventricle end-diastolic anterior wall to left ventricle end-diastolic posterior wall

目的评价超声心动图舒张末期右心室前壁厚度与舒张末期左心室后壁厚度比值(RVAW/LVPW)评估肺动脉高压(PAH)的临床价值。方法采用受试者工作特征曲线(ROC)评价RVAW/LVPW比值对入选202例单纯先天性室间隔缺损(VSD)患者肺动脉高压的诊断价值。结果 RVAW/LVPW比值与右心导管所测肺动脉平均压(MPAP)有良好相关性(r=0.732,P<0.001)。选RVAW/LVPW比值≥0.6为诊断肺动脉高压阳性(MPAP≥25 mm Hg)界点时,敏感性和特异性分别是80%和69%。选RVAW/LVPW比值≥0.9为诊断重度肺动脉高压(MPAP≥60 mm Hg)界点时,敏感性和特异性分别是93%和94%。结论超声心动图RVAW/LVPW比值可以用来评估室间隔缺损患者肺动脉高压的严重程度。

Objectives The aim of this study was to determine the prognostic value of other quantitative echoeardiographic criteria for pulmonary arterial hypertension （PAH） in patients with congenital ventricular septal defect（ the thickness ratio of the right ventricle end-diastolic anterior wall to the left ventricle end-diastolic posterior wall, RVAW/LVPW）. Methods A total of 202 patients with isolated congenital ventricular septal defect （VSD） were enrolled in this study and classified into 4 groups according to their mean pulmonary artery pressure（MPAP） by right-heart catheterization： A group without-PAH,with an MPAP of 〈 25 mm Hg; A group of mild-PAH, with an MPAP of ≥25 mm Hg and 〈 40 mm Hg; A group of moderate-PAH, with an MPAP of≥40 mm Hg and 〈60 mm Hg; A group of severe-PAH, with an MPAP of ≥ 60 mm Hg. Bivariate correlations were evaluated using Pearson＇ s correlation coefficient. The discriminatory ability of RVAW/LVPW ratio for PAH was assessed using the receiver operating characteristic curve （ROC）. Results The RVAW/LVPW was correlated well with MPAP measured by right-heart catheterization （r =0. 732,P 〈0. 001 ）. The sensitivity and specificity of RVAW/LVPW≥0.6 for predicting PAH defined as MPAP≥25 mm Hg were 80% and 69% , with a high area under the ROC （AUC, 0.80; 95% CI, 0. 76-0. 86 ） . The sensitivity and specificity of RVAW/LVPW ≥0.9 for diagnosing severe PAH （ MPAP≥60 mm Hg） were 93% and 94%, with a high AUC [ 0. 97 ; 95% CI, （ 0. 9±0.99 ） ]. Conclusion The RVAW/LVPW ratio derived from echocardiography has a good prognostic value in terms of the severity of PAH in patients with VSD .