经胸超声心动图在动脉性肺动脉高压危险分层评估的价值研究

Research about the value of TTE in the assessment of risk stratification for pulmonary arterial hypertension

目的:探讨经胸超声心动图(TTE)在动脉性肺动脉高压危险分层评估中的应用价值。方法:选取医院行超声心动图和右心导管插入术(RHC)检查的71例动脉性肺动脉高压患者,依据RHC检查结果将其按肺动脉高压危险评估为轻危组(27例,25~39 mmHg)、中危组(24例,40~69 mmHg)和重危组(20例,≥70 mmHg)3组。对3组患者的超声心动图测量参数右房压(RAP)、三尖瓣反流速度(TVR)、右室舒张末内径(RVED)、右心室面积变化分数(RVFAC)、肺动脉收缩压(PASP)、左室舒张末内径(LVED)、左室射血分数(LVEF)及左心室后壁厚度(LVPW)进行组间比较。患者TTE和RHC检查的肺动脉收缩压的相关性分析采用Pearson法,TTE在动脉性肺动脉高压危险分层评估的诊断价值采用受试者工作特征(ROC)曲线分析。结果:重危组超声心动图测量的RAP、TVR、RVED及PASP高于其他两组,差异均有统计学意义(F=4.650,F=5.363,F=34.315,F=93.418;P<0.05);轻危组RVFAC、LVED高于其他两组,差异均有统计学意义(F=23.56,F=47.559;P<0.05);LVEF和LVPW的组间差异无统计学意义。轻危组、中危组和重危组TTE测量的PASP分别与RHC相关性较好(r=0.814,r=0.780,r=0.736;P<0.05)。分别以RHC测量的PASP<40 mmHg和PASP>70 mmHg为诊断标准,TTE进行动脉性肺动脉高压轻危和重危患者诊断的灵敏度分别为85.00%和84.1%,特异度分别为92.2%和96.3%,轻危组和危重组鉴别诊断ROC曲线下面积(AUC)分别为0.958和0.952。结论:超声心动图在不同肺动脉压危险分层的动脉性肺动脉高压患者鉴别诊断中具有较高的准确性,与RHC诊断的一致性较好,对患者进行早期诊断和定期观察的临床意义明显。

Objective:To discuss the application value of transthoracic echocardiography(TTE)in the assessment of risk stratification for pulmonary arterial hypertension.Methods:Seventy-one patients with pulmonary arterial hypertension who underwent echocardiography and right heart catheterization(RHC)in hospital were selected.According to the results of RHC,they were divided into low-risk group(27 cases,25-39 mmHg),medium-risk group(24 cases,40-69 mmHg)and high-risk group(20 cases,≥70 mmHg)as the risk of pulmonary arterial hypertension.The parameters of echocardiographic measurements included right atrial pressure(RAP),tricuspid regurgitator velocity(TVR),right ventricular end-diastolic diameter(RVED),right ventricular fractional area change(RVFAC),pulmon ary artery systolic pressure(PASP),left ventricular end diastolic diameter(LVED),left ventricular ejection fraction(LVEF)and left ventricular posterior wall thickness(LVPW),and the differences of them among different groups were compared.Pearson method was adopted to implement correlation analysis of pulmonary arterial systolic pressure between TTE and RHC.The receiver operating characteristics(ROC)curve was adopted to analyze the diagnostic value of TTE in the assessment of risk stratification of pulmonary arterial hypertension.Results:The RAP,TVR,RVED and PASP measured by echocardiography of high-risk group were significantly higher than those of other groups(F=4.650,F=5.363,F=34.315,F=93.418,P<0.05).RVFAC and LVED of low-risk group were significantly higher than those of other groups(F=23.56,F=47.559,P<0.05).There were no statistically significant differences in LVEF and LVPW among different groups.The correlations between PASP was measured by TTE and RHC were favorable in low-risk group,medium-risk group and high-risk group(r=0.814,r=0.780,r=0.736,P<0.05),respectively.PASP<40mmHg and PASP>70mmHg which were measured by RHC were used as diagnostic criteria respectively,and the sensitivities of TTE which was used to diagnose patients with low and high-risk in pulmonary arterial hypertension were 85.00%and 84.1%,and the specificities of them were 92.2%and 96.3%,respectively.And the area under curves(AUCs)of ROC in differential diagnoses of low-risk and high-risk group were 0.958 and 0.952,respectively.Conclusion:Echocardiography has higher accuracy in the differential diagnosis of different risk stratification of patients with pulmonary arterial hypertension,which has favorable consistent with the diagnosis of RHC.And it has obvious clinical significance in implementing early diagnosis and regular observation for patients.