多普勒技术评估房间隔缺损合并肺动脉高压的应用价值

Application value of evaluation on atrial septal defect with pulmonary hypertension patients by Doppler techniques

目的探讨多普勒技术多种参数单独或协同评估房间隔缺损合并肺动脉高压(ASD-PAH)患者肺动脉压力的应用价值,分析各参数与右心漂浮导管术(RHC)测压的相关性。方法选取我院心胸外科拟行封堵术或修补术的ASD患者75例,所有患者均在24 h内完成经胸超声心动图检查和RHC测压。根据RHC所测肺动脉平均压(m PAP)分为肺动脉高压(PAH)组43例和非PAH组32例。比较两组三尖瓣反流峰值速度(VTR)和经三尖瓣反流法估测的肺动脉收缩压(s PAPTR)、三尖瓣环游离壁收缩期位移(TAPSE)及Tei指数;分析多普勒技术各参数与RHC测得的肺动脉收缩压(s PAP)、m PAP及肺动脉舒张压(d PAP)的相关性;受试者工作特征曲线分析VTR和Tei指数诊断PAH的截断值及对应的诊断效能。结果 (1)PAH组TAPSE较非PAH组明显降低,而VTR、s PAPTR、Tei指数均较非PAH组明显升高,差异均有统计学意义(均P<0.05);(2)VTR与s PAP、m PAP、d PAP均呈正相关(均P<0.001),以VTR=3.3 m/s为截断值诊断PAH的敏感性为83%,特异性为72%;(3)Tei指数与s PAP、m PAP、d PAP均呈正相关(均P<0.001),以Tei=0.51为截断值诊断PAH的敏感性为81%,特异性为71%;(4)联合应用VTR和Tei指数诊断PAH的敏感性提高至86%,特异性提高至93%。结论多普勒技术各参数在诊断ASD-PAH时均显示较高的实用价值,其中以Tei指数和VTR效果最显著,而将两者联合应用则能明显提高PAH诊断的敏感性和特异性。

Objective To explore the application value for atrial septal defect（ASD） with pulmonary hypertension（ASD-PAH） by Doppler techniques and its correlation with right heart floating catheter（RHC） pressure measurement.Methods Seventy-five ASD patients who were underwent closure or repair with cardiothoracic surgery in our hospital were selected.All patients completed transthoracic echocardiography and RHC pressure measurement within 24 h.All patients were divided into 43 patients with PAH（PAH group） and 32 patients without PAH（non-PAH group）according to mean pulmonary pressure（m PAP）.The peak velocity of tricuspid regurgitation（VTR）,Pulmonary artery systolic pressure estimated by tricuspid regurgitation（s PAPTR）,contraction displacement of free wall of tricuspid annulus（TAPSE）and Tei index of two groups were measured by Doppler tissue imaging,and the results were compared.The correlation between Doppler parameters and pulmonary artery systolic pressure（s PAP）,pulmonary artery mean pressure（m PAP） and pulmonary artery diastolic pressure（d PAP）measured by RHC were analyzed.Results（1）TAPSE of PAH group was significantly lower than that of non-PAH group（P〈0.05）,but VTR,s PAPTRand Tei index of PAH group were significantly higher than those in non-PAH groups（all P〈0.05）.（2）A positive correlation was found between VTRand s PAP,m PAP and d PAP（all P〈0. 001）. Taking VTRwas 3. 3 m/s as cutoff value,the sensitivity and specificity in diagnosis of PAH were 83% and 72%.（3）Tei index was positively correlated with s PAP,m PAP and d PAP（P〈0.001）,taking Tei index was 0.51 as cutoff value,the sensitivity and specificity in diagnosis of PAH were 81% and 71%.（4）The sensitivity and specificity of combined application of VTRand Tei index in diagnosis of PAH increased to 86% and 93%.Conclusion The Doppler parameters showed high practical value in the diagnosis of ASD-PAH,especially the Tei index and the VTR,while the combination of both parameters could obviously improve the sensitivity and specificity of PAH diagnosis.