右心声学造影在肺动脉高压合并低氧血症患者中的应用价值

Clinical Value of Right Heart Contrast Echocardiography in Patients With Pulmonary Hypertension and Hypoxemia

目的:探讨右心声学造影在肺动脉高压合并低氧血症中的应用价值。方法:回顾性分析2018年5月至2022年10月期间在中国医学科学院阜外医院住院治疗的32例肺动脉高压合并低氧血症患者(病例组)的临床资料和右心声学造影检查结果;另选30例年龄、性别匹配的临床疑诊卵圆孔未闭行右心声学造影的患者为对照组。记录右心声学造影结果、声学造影剂臂心时间,分析其与血液动力学指标、右心大小之间的相关性,并分析与无事件生存之间的关系。结果:病例组平均年龄(43.4±17.4)岁,中位随访时间16.4(8.8,25.4)个月。病例组中右心声学造影阳性18例,病例组与对照组相比,右心声学造影剂臂心时间显著延长[(9.3±2.4)s vs.(4.0±1.5)s,P<0.01]。臂心时间与右心房压(r=0.532,P=0.002)、肺血管阻力(r=0.618,P<0.01)、肺动脉平均压(r=0.648,P<0.01)、右心房与左心房左右径比值(r=0.596,P<0.01)和右心室与左心室基底段左右径比值(r=0.624,P<0.01)均呈中度正相关,与三尖瓣环收缩期位移(r=-0.573,P<0.01)呈中度负相关,差异均有统计学意义。ROC曲线分析结果表明,右心声学造影剂臂心时间9.5 s为截断值(cut-off值),Kaplan-Meier生存分析表明臂心时间越长,肺动脉高压临床恶化事件发生风险越高(log-rank P=0.012)。结论:右心声学造影检查对肺动脉高压合并低氧血症的诊断和病情评估发挥重要作用,臂心时间可反映病情严重程度并判断预后。

Objectives:To explore the clinical application value of right heart contrast echocardiography in patients with pulmonary hypertension and hypoxemia.Methods:Clinical data and right heart contrast echocardiography results of 32 consecutive patients with pulmonary hypertension and hypoxemia(case group),who were hospitalized in our hospital from May 2018 to October 2022,were retrospectively analyzed,and 30 age and sex matched adults who were clinically suspected of patent foramen ovale and underwent right heart contrast echocardiography were selected as the control group.The results of right heart contrast echocardiography were recorded,and the correlation between agent arm-to-heart time and hemodynamic parameters,right heart size,and event-free survival was explored.Results:The average age of the 32 patients was(43.4±17.4)years.The median follow-up time was 16.4(8.8,25.4)months.In the case group,there were 18 cases with positive results.Compared with the control group,the arm-to-heart time was significantly prolonged([9.3±2.4]s vs.[4.0±1.5]s,P<0.01).Arm-to-heart time was moderately correlated with right atrial pressure(r=0.532,P=0.002),pulmonary vascular resistance(r=0.618,P<0.01),mean pulmonary artery pressure(r=0.648,P<0.01),ratio of right atrial to left atrial diameter(r=0.596,P<0.01)and ratio of right ventricular to left ventricular diameter(r=0.624,P<0.01),and moderately negatively correlated with tricuspid annular plane systolic excursion(r=-0.573,P<0.01).The results of ROC curve analysis showed that 9.5 s was the cut-off value of the arm-to-heart time.The longer the arm-toheart time,the higher the risk of clinical deterioration(log-rank P=0.012).Conclusions:The right heart contrast echocardiography plays an important role in the diagnosis and evaluation of pulmonary hypertension with hypoxemia.The arm-to-heart time of contrast agent could reflect the severity of the disease and predict the prognosis.