超声心动图评分系统预测肺动脉高压的血流动力学特征

Prediction of echocardiographic scoring system on hemodynamic characteristics of pulmonary hypertension

目的评价超声心动图评分系统无创评估肺动脉高压患者血流动力学特征.方法选取同济大学附属上海市肺科医院肺循环科2015年8月至2018年7月经右心导管检查确诊的左心疾病相关性肺动脉高压,即血流动力学为毛细血管后肺动脉高压(post-PH)患者85例,并回顾性抽样同期经右心导管检查确诊的动脉性肺动脉高压,即血流动力学为毛细血管前肺动脉高压(pre-PH)患者65例.分析2组患者超声心动图各参数的差异,利用logistic回归分析建立区分肺动脉高压患者2种血流动力学特征模型.结果经多因素回归分析显示,左心房内径、左心室收缩末期内径、右心房压力、二尖瓣E/Em为post-PH患者的独立预测因素.建立超声心动图评分系统[左心房内径≥38.5mm为2分,左心室收缩末期内径≥28.5mm为1分,右心房压力≥8 mmHg(1 mmHg=0.133 kPa)为1分,二尖瓣E/Em≥8.6为1分].利用该评分系统≥2分诊断post-PH的曲线下面积为0.969,敏感度为95.3%,特异度为89.2%.结论利用上述超声心动图评分系统≥2分有助于预测肺动脉高压患者血流动力学为post-PH.

Objective To evaluate noninvasive assessment of hemodynamic characteristics of pulmonary hypertension(PH)patients by an echocardiographic scoring system.Methods 85 patients with PH due to left heart diease,in whom the hemodynamics was post-capillary pulmonary hypertension(post-PH),diagnosed by right heart catheter from August 2015 to July 2018 in the Department of Pulmonary Circulation,Shanghai Pulmonary Hospital,Tongji University were selected,and 65 patients with arterial pulmonary hypertension,in whom the hemodynamics was pre-capillary pulmonary hypertension,diagnosed by right heart catheter during the same period were selected.The differences of the echocardiographic parameters between the two groups were analyzed,and a model was established to distinguish the two kinds of hemodynamics in patients with PH by logistic regression analysis.Results Multivariate regression analysis showed that left atrial diameter,left ventricular end systolic diameter,right atrial pressure and mitral-E/Em were independent predictors of post-PH patients.The echocardiographic scoring system was established[two for left atrial diameter≥38.5 mm,one for left ventricular end systolic diameter≥28.5 mm,one for right atrial pressure≥8 mmHg(1 mmHg=0.133 kPa),and one for mitral-E/Em≥8.6].The sensitivity and specificity of the score≥2 for predicting post-PH were 95.3%and 89.2%,respectively(area under curve was 0.969).Conclusions The above echocardiographic score≥2 is helpful to predict the hemodynamics as post-PH in PH patients.