摘要
目的探讨超声二维及三维参数预测慢性肺血栓栓塞性肺动脉高压(CTEPH)肺血管阻力(PVR)的价值。方法回顾性及前瞻性纳入2015年11月至2022年12月在中日友好医院确诊CTEPH的患者141例。根据PVR计算公式构建反映PVR的二维超声指标:超声估测肺动脉收缩压(sPAPEcho)/左心室舒张末期内径(LVIDd)、肺动脉平均压(mPAPEcho)/LVIDd;三维超声指标:sPAPEcho/左心室舒张末期容积(LVEDV)、sPAPEcho/左心室心输出量(LVCO)。采用Spearman相关分析法分析二维及三维超声指标与右心导管所测PVR的相关性。采用ROC曲线分析超声心动图参数预测PVR>1000 dyn·s-1·cm-5的曲线下面积(AUC)及临界值。分析54例进行肺动脉血栓内膜剥脱术(PEA)患者术前、术后的超声及血流动力学参数的变化,以及超声指标降低率与PVR降低率的相关性。结果sPAPEcho/LVIDd、sPAPEcho/LVEDV、sPAPEcho/LVCO与PVR呈中度相关(rs=0.62、0.52、0.63,均P<0.001)。sPAPEcho/LVEDV预测PVR>1000 dyn·s-1·cm-5的AUC为0.860,最佳截断值为≥1.41,敏感性为0.800,特异性为0.933。sPAPEcho/LVIDd预测PVR>1000 dyn·s-1·cm-5的AUC为0.830,最佳截断值为≥2.14,敏感性为0.647,特异性为0.861。与术前相比,PEA术后sPAPEcho/LVIDd和mPAPEcho/LVIDd显著降低(均P<0.001)。sPAPEcho/LVIDd降低率(ΔsPAPEcho/LVIDd)和mPAPEcho/LVIDd降低率(ΔmPAPEcho/LVIDd)与PVR降低率(ΔPVR)显著相关(rs=0.61、0.63,均P<0.05)。结论二维超声指标sPAPEcho/LVIDd及三维超声指标sPAPEcho/LVEDV可用于无创估测CTEPH患者的PVR。sPAPEcho/LVIDd更便捷,适用于监测治疗前后PVR改善情况,sPAPEcho/LVIDd≥2.14可预测CTEPH患者PVR显著升高(>1000 dyn·s-1·cm-5)。
Objective To investigate the values of two-dimensional and three-dimensional echocardiographic parameters in predicting pulmonary vascular resistance(PVR)in chronic pulmonary thromboembolic pulmonary hypertension(CTEPH).Methods A total of 141 patients diagnosed with CTEPH in China-Japan Friendship Hospital from November 2015 to December 2022 were included.Two-dimensional echocardiographic indicators reflecting PVR were constructed according to the calculation formula of PVR:echocardiographic estimated systolic pulmonary artery pressure(sPAPEcho)/left ventricular end-diastolic diameter(LVIDd),echocardiographic estimated mean pulmonary artery pressure(mPAPEcho)/LVIDd.sPAPEcho/left ventricular end-diastolic volume(LVEDV),sPAPEcho/left ventricular cardiac output(LVCO)were measured by three-dimensional echocardiography.The correlations between two-dimensional and three-dimensional echocardiographic ratios and invasive PVR were then analyzed using the Spearman correlation method.Using receiver operating characteristic curve analysis,cut-off values for the ratios were generated to identify patients with PVR>1000 dyn·s-1·cm-5.Pre-and postoperative hemodynamics and echocardiographic data were analyzed,as well as the correlation between the reduction rate of the echocardiographic index and PVR in 54 patients who underwent pulmonary endarterectomy(PEA).Results sPAPEcho/LVIDd,sPAPEcho/LVEDV and sPAPEcho/LVCO were moderately correlated with PVR(rs=0.62,0.52,0.63,both P<0.001).The ratio of sPAPEcho to LVEDV,when greater than or equal to 1.41,had a sensitivity of 0.800 and a specificity of 0.930 for determining PVR>1000 dyn·s-1·cm-5(AUC=0.860,P<0.001).Similarly,the ratio of sPAPEcho to LVIDd,when greater than or equal to 2.14,had a sensitivity of 0.647 and a specificity of 0.861 for determining PVR>1000 dyn·s-1·cm-5(AUC=0.830,P<0.001).The sPAPEcho/LVIDd and mPAPEcho/LVIDd significantly decreased after PEA(both P<0.001).The sPAPEcho/LVIDd and mPAPEcho/LVIDd reduction rate(ΔsPAPEcho/LVIDd andΔmPAPEcho/LVIDd)were significa
作者
翟亚楠
李爱莉
谢万木
黄强
高倩
张郁
陈爱红
吕广洁
雷洁萍
翟振国
Zhai Yanan;Li Aili;Xie Wanmu;Huang Qiang;Gao Qian;Zhang Yu;Chen Aihong;Lyu Guangjie;Lei Jieping;Zhai Zhenguo(Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,Center for Respiratory Diseases,China-Japan Friendship Hospital,Beijing 100029,China;Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2024年第2期134-141,共8页
Chinese Journal of Ultrasonography
基金
首都卫生发展科研专项(2020-2-4063)
中国医学科学院与健康科技创新工程(2018-I2M-1-003)
国家临床重点专科建设项目(2020-QTL-009)。
