左右心功能相关参数及心室内径比值评估高原性肺动脉高压心功能损伤的价值分析

Value analysis of left and right ventricular function-related parameters and ventricular inner diameter ratio in evaluating cardiac function impairment in patients with high altitude pulmonary hypertension

目的:研究左右心功能相关参数及心室内径比值评估高原性肺动脉高压(HPAH)心功能损伤的价值。方法:选取2019年4月—2022年4月我院收治的118例HPAH患者,根据是否发生心功能损伤分为阳性组和阴性组,所有患者均接受斑点追踪显像和心脏多普勒彩色超声检查。对比两组患者三尖瓣环收缩期位移(TAPSE)参数(三尖瓣环右心室游离壁部位移(TAPSEfw)、三尖瓣环中点部位移(TAPSmid)和三尖瓣环间隔部位移(TAPSEint))、左右心功能相关参数(左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)、右心室射血分数(RVEF)、右心室收缩压(RVSP))及右心室基底段与左心室基底段比值(RVRDd/LVTDd),绘制ROC曲线分析TAPSE联合左右心功能相关参数及RVRDd/LVTDd对HPHA合并心功能损伤的诊断价值。结果:与阴性组患者相比,阳性组患者TAPSEfw、TAPSmid、TAPSEint、LVEDV、LVEF及RVEF显著降低,RVRDd/LVTDd和RVSP显著升高,差异具有统计学意义(P<0.05);TAPSEfw、TAPSmid、TAPSEint、LVEDV、LVEF、RVEF、RVSP及RVRDd/LVTDd诊断HPAH合并心功能损伤的AUC分别为0.728、0.755、0.730、0.653、0.683、0.767、0.730和0.704,灵敏度分别为77.0%、81.4%、79.2%、76.4%、72.2%、79.9%、78.3%和63.7%,特异度分别为69.9%、72.2%、77.1%、73.8%、79.8%、84.9%、80.5%和81.0%;各指标联合诊断的AUC为0.858,灵敏度为87.2%,特异度为92.2%;各指标联合诊断的AUC、灵敏度和特异度均高于各项单独检测(P<0.05)。结论:左右心功能相关参数及RVRDd/LVTDd对HPAH合并心功能损伤的诊断价值较高,各指标联合诊断的AUC、灵敏度和特异度均高于各项单独检测。

Objective:To investigate the value of left and right ventricular function parameters and the ratio of ventricular inner diameter in evaluating cardiac function impairment in patients with high altitude pulmonary hypertension(HPAH).Methods:One hundred and eighteen patients with HPAH admitted to our hospital from April 2019 to April 2022 were enrolled,and were classified into two groups according to the presence or absence of cardiac function impairment,positive group and negative group.All patients underwent speckle tracking imaging and cardiac Doppler color ultrasound.Then comparison was conducted on tricuspid annular plane systolic excursion(TAPSE)parameters(displacement of TAPSE at the free wall of right ventricular(TAPSEfw),at the midpoint(TAPSmid)and at the interventricular septum(TAPSEint)),left and right cardiac function parameters(left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF),right ventricular systolic pressure(RVSP)),and right ventricular to left ventricular transverse diameter ratio(RVRDd/LVTDd).Receiver operating characteristic(ROC)curve was plotted to evaluate the value of the diagnostic value of TAPSE combined with left and right ventricular function-related parameters and RVRDd/LVTDd for HPAH complicated with cardiac function impairment.Results:TAPSEfw,TAPSmid,TAPSEint,LVEDV,LVEF and RVEF were significantly lower,and RVRDd/LVTDd and RVSP were remarkably higner in the positive group compared to the negative group(all P<0.05).The AUC of TAPSEfw,TAPSmid,TAPSEint,LVEDV,LVEF,RVEF,RVSP,and RVRDd/LVTDd for the prediction of HPHA complicated with cardiac function impairment were 0.728,0.755,0.730,0.653,0.683,0.767,0.730,and 0.704,with the sensitivities of 77.0%,81.4%,79.2%,76.4%,72.2%,79.9%,78.3%and 63.7%,and the specificities were 69.9%,72.2%,77.1%,73.8%,79.8%,84.9%,80.5%and 81.0%,respectively.Analysis denoted that the AUC(0.858),sensitivity(87.2%)and specificity(92.2%)of the combined detection of the above parameters were higher than those of the separate detection(P<0.05).Conclusion:Left and right cardiac function parameters and RVRDd/LVTDd have high diagnostic value for HPAH combined with cardiac function impairment,and the combined AUC,sensitivity and specificity of each index are higher than those of each single test.