CT肺动脉成像联合心脏超声对肺动脉高压患者心功能损害的诊断价值

Diagnosis value of CT pulmonary artery imaging combined with echocardiography in cardiac function damage for patients with pulmonary hypertension

目的探讨CT肺动脉成像联合心脏超声对肺动脉高压(PAH)患者心功能损害的诊断价值。方法回顾性分析2018年2月—2019年10月重庆三峡中心医院163例PAH患者的临床资料。统计心功能损害发生情况;比较发生组和未发生组CT肺动脉成像和心脏超声有关参数;绘制受试者工作特征(ROC)曲线,分析CT肺动脉成像联合心脏超声对PAH患者心功能损害的诊断效能。结果163例PAH患者中,39例发生心功能损害,发生率为23.93%。发生组肺动脉直径、右室横径大于未发生组(P<0.05),右心室收缩压(RVSP)高于未发生组(P<0.05),右心室射血分数(RVEF)、三尖瓣环收缩期位移(TAPSE)低或小于未发生组(P<0.05)。ROC曲线显示,肺动脉直径、右室横径、RVEF、RVSP、TAPSE评估PAH患者心功能损害的最佳截断值分别为23.15 mm、42.75 mm、34.83%、53.78 mmHg、16.03 mm;CT肺动脉成像的敏感性、特异性及ROC曲线下面积(AUC)分别为64.1%(95%CI:0.597,0.687)、90.3%(95%CI:0.852,0.992)、0.843(95%CI:0.778,0.895);心脏超声的敏感性、特异性及AUC分别为61.5%(95%CI:0.573,0.649)、92.7%(95%CI:0.881,0.947)、0.827(95%CI:0.760,0.882);CT肺动脉成像、心脏超声对PAH患者心功能损害的诊断效能相近(P>0.05);CT肺动脉成像联合心脏超声的敏感性、特异性及AUC分别为64.1%(95%CI:0.596,0.686)、99.2%(95%CI:0.952,1.032)、0.917(95%CI:0.853,0.958),CT肺动脉成像联合心脏超声对PAH患者心功能损害诊断效能的AUC大于肺动脉直径、右室横径、RVEF、RVSP、TAPSE单独诊断的AUC(P<0.05)。结论CT肺动脉成像联合心脏超声对PAH患者心功能损害的诊断效能较高,二者联合适用于对PAH患者患者心功能损害进行诊断。

Objective To explore the value of CT pulmonary artery imaging combined with echocardiography in the evaluation of cardiac function damage in patients with pulmonary hypertension(PAH).Methods The clinical data of 163 patients with PAH from February 2018 to October 2019 were analyzed retrospectively. Incidence of cardiac function damage was recorded. The parameters of CT pulmonary artery imaging and echocardiography between the two groups were compared. Receiver operating characteristic curve(ROC) was drawn and used to analyze the evaluation effect of CT pulmonary artery imaging combined with echocardiography in evaluating cardiac function damage in PAH patients. Results Among 163 patients with PAH, 39 had cardiac dysfunction, the incidence was 23.93%. Pulmonary artery diameter, right ventricular transverse diameter, and right ventricular systolic pressure(RVSP) in the occurrence group were higher than those in the non occurrence group(P < 0.05), while right ventricular ejection fraction(RVEF) and tricuspid annular plane systolic excursion(TAPSE)were lower than those in the non occurrence group(P < 0.05). ROC analysis showed that the best cut off points of pulmonary artery diameter, right ventricular transverse diameter, RVEF, RVSP, and TAPSE were 23.15 mm, 42.75 mm,34.83%, 53.78 mmHg, and 16.03 mm, respectively. The sensitivity, specificity, and area under curve(AUC) of CT pulmonary artery imaging were 64.1%(95% CI: 0.597, 0.687), 90.3%(95% CI: 0.852, 0.992), and 0.843(95% CI:0.778, 0.895), respectively. The sensitivity, specificity, and AUC of echocardiography were 61.5%(95% CI: 0.573,0.649), 92.7%(95% CI: 0.881, 0.947), and 0.827(95% CI: 0.760, 0.882), respectively. CT pulmonary angiography and echocardiography were similar in evaluating cardiac function damage in patients with PAH(P > 0.05). The sensitivity, specificity, and AUC of CT pulmonary angiography combined with echocardiography were 64.1%(95% CI: 0.596, 0.686), 99.2%(95% CI: 0.952, 1.032), 0.917(95% CI: 0.853, 0.958), which the AUC were higher than those of pulmonary artery diameter, right ventricular transverse diameter, RVEF, RVSP, and TAPSE alone(P <0.05). Conclusion CT pulmonary artery imaging combined with echocardiography is more effective the cardiac function damage of PAH patients, and the combination of them is suitable for evaluating the cardiac function damage of PAH patients.