超声心动图联合CT下肺动脉造影评价肺动脉高压患者心功能不全的诊断效能

Value of echocardiography combined with computed tomography pulmonary angiography in evaluating cardiac dysfunction in patients with pulmonary hypertension

目的探讨超声心动图联合CT下肺动脉造影(CTPA)评价肺动脉高压(PAH)患者心功能不全的诊断效能。方法选择2018年6月至2020年8月宁波市第六医院收治的PAH患者142例。根据是否发生心功能不全将PAH患者分为观察组37例和对照组105例。比较两组超声心动图和CTPA检查有关参数水平。绘制ROC曲线,分析超声心动图联合CTPA评价PAH患者心功能不全的诊断效能。结果观察组右心室收缩压(RVSP)水平高于对照组,右心室射血分数(RVEF)、三尖瓣环收缩期位移(TAPSE)水平低于对照组,差异均有统计学意义(均P<0.05)。观察组肺动脉直径、右心室横径均大于对照组,差异均有统计学意义(均P<0.05)。ROC曲线结果显示,RVEF、RVSP、TAPSE 3者联合预测心功能不全的AUC>3项指标单独预测的AUC。肺动脉直径、右心室横径两者联合预测心功能不全的AUC大于肺动脉直径、右心室横径单独的AUC。超声心动图联合CTPA预测心功能不全的AUC为0.913,大于超声心电图和CTPA单独预测。结论超声心动图联合CTPA有利于预测PAH患者的心功能不全。

Objective Explore the value of echocardiography combined with computed tomography pulmonary angiography(CTPA)in evaluating cardiac dysfunction in patients with pulmonary hypertension(PAH).Methods One hundred and forty-two PAH patients who were diagnosed and treated at Ningbo NO.6 Hospital from June 2018 to August 2020 were selected.The patients were divided into an observation group(37 cases)with cardiac dysfunction and a control group(105 cases)without cardiac dysfunction.Echocardiography and CTPA parameters were compared between the two groups.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of echocardiography combined with CTPA in evaluating cardiac dysfunction in patients with PAH.Results Right ventricular systolic pressure(RVSP)was significantly higher,right ventricular ejection fraction(RVEF)and tricuspid annular plane systolic excursion(TAPSE)were significantly lower in the observation group than in the control group(all P<0.05).Pulmonary artery diameter and right ventricular transverse diameter were significantly higher in the observation group than in the control group(all P<0.05).ROC showed that the area under the curve(AUC)of a combination of RVEF,RVSP and TAPSE was significantly higher than that of each parameter,pulmonary artery diameter combined with right ventricular transverse diameter was significantly higher than each one,in predicting cardiac dysfunction(all P<0.05).The AUC of echocardiography combined with CTPA was 0.913,higher than that of echocardiography or CTPA alone.Conclusion A combination of echocardiography and CTPA may improve prediction of cardiac dysfunction in PAH patients.