超声心动图与心导管检查评估肺动脉高压患者血流动力学指标的相关性分析

Correlation between echocardiography and cardiac catheterization in assessment of hemodynamics in patients with pulmonary arterial hypertension

目的:分析超声心动图与心导管检查评估肺动脉高压(PAH)患者血流动力学指标的相关性,评价应用超声心动图检测PAH病情严重程度的可靠性。方法:入选2015年9月至2016年11月入住我科的PAH患者,进行同步(检查时间相距不超过24h)超声心动图和右心导管检查(RHC),根据是否存在心脏解剖畸形分为分流组和无分流组。将超声心动图估测的肺动脉收缩压(Echo-SPAP)与RHC测得的肺动脉收缩压(RHC-SPAP)进行配对t检验及相关性分析,超声心动图测得的肺动脉/主动脉内径比(PA/AO)、三尖瓣瓣环收缩期运动位移(TAPSE)分别与RHC-SPAP和肺小动脉阻力(PVR)行相关性分析。根据是否为重度PAH作Echo-SPAP受试者工作曲线(ROC曲线)。结果:入组67例患者,平均年龄(23.7±14.8)岁,男性17例,女性50例,分流组49例,无分流组18例。Echo-SPAP和RHC-SPAP呈显著正相关(r=0.894,P<0.001),但两者的差异有统计学意义(P=0.001),Echo-SPAP低于RHCSPAP。ROC曲线结果显示Echo-SPAP以63.5mm Hg(1mm Hg=0.133Kpa)作为诊断重度PAH界点时敏感度和特异度分别是86.4%和78.3%,曲线下面积是0.948。相关性分析结果显示无分流组PA/AO比值与RHC-SPAP和PVR均呈显著正相关(r=0.620、0.529,P<0.01);TAPSE与RHC-SPAP和PVR均呈显著负相关(r=-0.664、-0.703,P<0.01),但分流组的相关性均无统计学意义。结论:Echo-SPAP与RHC-SPAP有良好的相关性,但超声心动图易低估肺动脉收缩压;PA/AO比值以及TAPSE可以用来评估心内及大血管水平无分流患者肺动脉高压的严重程度,但对于心内及大血管水平有分流的患者评估价值不大。

Objective：To evaluate the reliability of echocardiography in testing the severity of PAH, we analyzed the correlation between echocardiography and right heart catheterization （RHC） in assessing hemody- namics of patients with PAH. Methods ： We enrolled the patients with PAH who received echocardiography and RHC（Interval less than 24h） from January 2015 to November 2016. According to the anatomical abnormalities, the patients were divided into two groups： shunt group; no shunt group. Pulmonary artery systolic pressure of echocardiography（Echo-SPAP） was compared with pulmonary artery systolic pressure of echocardiography. PA/ AO ratio and tricuspid annular plane systolic excursion were compared with pulmonary artery systolic pressure and pulmonary artery resistance of RHC. Correlations were evaluated using Spearman correlation coefficient. The discriminatory ability of Echo-SPAP for severe PAH was assessed using receiver operating characteristic curve （ROC）. Results： 67 patients were included, 11 male and 50 female, mean age （23.7 ± 14. 8） years. Shut group include 49 patients, and no shunt group include 18 patients. The pulmonary artery systolic pressure estimated by echocardiography was well correlated with the pulmonary artery systolic pressure measured by right heart catheterization （r = 0. 894, P 〈 0. 001 ）, But the difference was statistically significant （P = 0. 001 ）. Ech- o - SPAP was lower than RHC - SPAP. The sensitivity and specificity of pulmonary artery systolic pressure esti- mated by echocardiography≥63.5 mmHg for diagnosising severe pulmonary hypertension is higher. The PA / AO ratio in group B was significantly correlated with the pulmonary artery systolic pressure and pulmonary artery resistance measured by RHC （ r = 0. 620,0. 529,P 〈 0. 01 ）, and there was no correlation in shunt group. In no shunt group, TAPSE was well correlated with pulmonary artery systolic pressure and pulmonary arterial resist- ance measured by RHC（r = -0. 664, -0. 703 ,P 〈0.01 ）, and there was no correlation in shunt group. Con- clusion ： Pulmonary artery systolic pressure estimated by echocardiographic correlated well with right heart cath- eterization. But echocardiography tends to underestimate the pulmonary artery systolic pressure. PA / AO ratio and TAPSE are indirect indicators of pulmonary artery pressure in patients without shunt.