首页|无创性超声指标预测慢性血栓栓塞性肺动脉高压肺血管阻力的价值

无创性超声指标预测慢性血栓栓塞性肺动脉高压肺血管阻力的价值

Value of noninvasive echocardiographic indicators in predicting pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension

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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>1 000 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(r s＝0.62、0.52、0.63，均P<0.001)。sPAPEcho/LVEDV预测PVR> 1 000 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>1 000 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(r s＝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(>1 000 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>1 000 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(r s=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 >1 000 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 and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively (r s=0.61, 0.63, both P<0.05). Conclusions Two-dimensional ratio sPAPEcho/LVIDd and three-dimensional ratio sPAPEcho/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAPEcho/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 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>1 000 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(r s=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 >1 000 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 and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively (r s=0.61, 0.63, both P<0.05). Conclusions Two-dimensional ratio sPAPEcho/LVIDd and three-dimensional ratio sPAPEcho/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAPEcho/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 dyn·s-1·cm-5).

EchocardiographyChronic thromboembolic pulmonary hypertensionPulmonary vascular resistancePulmonary endarterectom

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

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中日友好医院心脏科，北京　100029

中日友好医院呼吸与危重症医学二部，北京　100029

中日友好医院临床医学研究所，北京　100029

超声心动描记术 慢性血栓栓塞性肺动脉高压 肺血管阻力 肺动脉血栓内膜剥脱术

首都卫生发展科研专项中国医科院与健康科技创新工程项目国家临床重点专科建设项目Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences

2020-2-40632018-I2M-1-0032020-QTL-009CIFMS 2018-I2M-1-003

2024

10.3760/cma.j.cn131148-20230907-00098

中华超声影像学杂志
中华医学会

中华超声影像学杂志

CSTPCD北大核心
影响因子：0.986
ISSN：1004-4477
年,卷(期)：2024.33(2)
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