超声心动图、ECG及联合检查对PAH-CHD肺动脉压力的预测价值观察

Predictive Value of Echocardiogram, ECG and Combination Examination for Pulmonary Artery Pressure of PAH-CHD

目的探讨超声心动图、心电图(ECG)及联合检查对先天性心脏病相关性肺动脉高压(PAH-CHD)肺动脉压力的预测价值。方法选取我院2017年1月-2018年9月收治的80例CHD患者为研究对象并开展回顾性分析,所有患者均行超声心动图及ECG检查,依据是否并发PAH将以上研究对象分为PAH组(36例)和非PAH组(44例),比较两组的超声心动图指标(肺动脉收缩压)及心电图指标(RV5振幅),绘制肺动脉收缩压、RV5振幅预测PAH-CHD肺动脉压力的ROC曲线,分析两者分别检查及联合的预测价值。结果 PAH组的肺动脉收缩压与RV5振幅均显著高于非PAH组(P<0.05);超声心动图指标预测PAH-CHD的灵敏度为72.1%,特异度为77.8%,心电图指标预测PAH-CHD的灵敏度为62.8%,特异度为69.4%,两者联合预测PAH-CHD的灵敏度为67.4%,特异度为83.3%;ROC曲线显示,两种检查方法的曲线下面积AUC与0.5比较差异显著(P<0.05),两种方法联合诊断的曲线下面积AUC均大于超声心动图、心电图单独诊断。结论超声心动图联合心电图检查对于PAH-CHD具有一定预测价值,且相较于单独检查能够提高准确度。

Objective To investigate the predictive value of echocardiogram, electrocardiogram(ECG) and combination examination for pulmonary artery pressure of pulmonary arterial hypertension associated with congenital heart disease(PAH-CHD). Methods 80 CHD patients who were admitted to the hospital from January 2017 to September 2018 were enrolled in the study. And retrospective analysis was conducted. All patients underwent echocardiogram and ECG. They were divided into PAH group(36 cases) and non-PAH group(44 cases) according to presence or absence of PAH. The echocardiogram index(pulmonary artery systolic pressure) and ECG index(RV5 amplitude) were compared between the two groups. The ROC(receiver operating characteristic) curves that pulmonary artery systolic pressure and RV5 amplitude predicted pulmonary artery pressure of PAH-CHD were drawn. The predictive value of the two and their combination was analyzed. Results The pulmonary artery systolic pressure and RV5 amplitude in PAH group were significantly higher than those in non-PAH group(P<0.05). The sensitivity and specificity of echocardiogram index for predicting PAH-CHD were 72.1% and 77.8%, respectively. The above 2 indexes of ECG index were 62.8% and 69.4%, respectively. The above 2 indexes of their combination were 67.4% and 83.3%, respectively. The ROC curve showed that there were significant differences between AUC(area under the ROC curve) of the two examination methods and 0.5(P<0.05). AUC of their combination diagnosis was greater than that of echocardiogram and ECG alone. Conclusion There is certain predictive value of echocardiogram combined with ECG for PAH-CHD, which improve accuracy compared with the single examination.