超声心动图评估肺动脉高压的研究进展

正肺动脉高压是由多种心脏、肺脏或者肺血管本身疾病所引起的一类疾病,表现为肺循环的压力和阻力进行性增加,导致右心负荷增大、右心功能不全及肺血流减少,从而引起一系列临床表现~([1-2])。目前广泛采用的肺动脉高压血流动力学的定义为:在海平面静息状态下,右心导管检查测定肺动     

经胸超声心动图和右心导管检测评估肺动脉高压患者血流动力学参数的比较

目的 探讨经胸超声心动图(TTE)和右心导管检查(RHC)评估肺动脉高压(PAH)患者血流动力学参数的价值.方法 选取2017年10月至2019年10月于河北医科大学第二医院心内科收治的PAH患者78例.根据肺动脉收缩压(sPAP)分为轻度28例,中度31例和重度19例.采用TTE和RHC测量PAH患者血流动力学参数,...     

多普勒超声心动图评估肺动脉压力的临床价值

目的:比较多普勒超声心动图(DE)和右心导管检查(RHC)估测肺动脉压力(PAP)值有无差异。方法:连续入选2006年1月1日至2017年11月1日,就诊于大连医科大学附属第一医院同时行RHC和DE的患者,根据是否存在心脏解剖畸形分为先天性心脏病(CHD)组和无分流组,排除14岁及存在右心室流出道梗阻和肺动脉瓣狭窄或其他复杂等畸形的患者。肺动脉高压(PAH)诊断标准参照2015年ESC/ERS肺动脉高压诊断与治疗指南。结果:研究共纳入347例患者,其中CHD组312例,无分流组35例。RHC确诊PAH患者269例(77. 5%),SPAP [50. 81(35,55)]mm Hg(1 mm Hg=0. 133k Pa);无PAH患者78例(22. 5%),SPAP [25. 58(24,29)]mm Hg。两组在年龄、体质量、心功能不全、红细胞分布宽度、BNP、右心室流出道宽度、右心室内径、左心房前后径、右心房前后径、右心房上下径及肺动脉内径等,差异均有统计学意义。年龄、体质量是患者发生PAH的影响因素,年龄大、体质量大的患者PAH发生风险增加(OR=1. 022,1. 028,P=0. 038,0. 046);缺损直径大小是CHD发生PAH的影响因素,缺损直径越大,发生PAH风险越高(OR=1. 063,P=0. 004)。在RHC确诊的的269例PAH患者中,发现RHC估测SPAP高于DE估测SPAP[50. 81(35,55) vs. 41. 19(22,53. 5) mm Hg,P0. 001],而无分流组中估测SPAP值,差异无统计学意义[69. 42(44. 5,87) vs. 70. 48(44. 5,93) mm Hg,P=0. 846];但二者估测的SPAP呈正相关(r=0. 598,P0. 001)。SPAP36 mm Hg时,DE确诊PAH灵敏性和特异性最高,分别为71. 7%和64. 3%。结论:应用DE估测的SPAP与RHC估测的SPAP值相关性较好,但二者仍存在一定差异,DE估测的SPAP低于RHC估测的SPAP; DE在评估无分流PAH患者SPAP准确性较高。     

肺动脉高压患者三尖瓣环收缩期位移/肺动脉收缩压比值与右心导管血流动力学参数的相关性研究

目的:本研究旨在探讨特发性肺动脉高压(IPAH)及先天性心脏病相关肺动脉高压(CHD-PAH)患者,三尖瓣环收缩期位移(TAPSE)与肺动脉收缩压(PASP)比值与临床指标及右心导管血流动力学参数之间的相关性.方法:回顾性分析2015年9月至2016年11月,北京安贞医院小儿心脏中心收治的IPAH及CHD-PAH患者,...     

41例闭塞性肺动脉高压患者应用多普勒超声心动图法与右心导管法测定肺动脉压力的比较

目的:评价多普勒超声心动图法估测肺动脉收缩压(PASP)的可靠性.方法:用右心导管法(RHC)与多普勒超声心动图法分别测定闭塞性肺动脉高压患者的PASP,并将其结果进行比较.结果:多普勒超声心动图法与右心导管法测量PASP值,两者间比较有显著性差异(P＜0.05),平均差为(11.85±5.02)mmHg(1 mmHg=0.133 kPa),但两种方法得到的数值具有一定的相关性(r=0.635,P＜0.05).PASP值与动脉二氧化碳分压、肺泡-动脉氧差、血氧饱和度有关.结论:多普勒超声心动图法测量PAPS值与右心导管法有相关性,多普勒超声心动图法可作为估测肺动脉压力的一种可靠的无创检查方法.     

肺动脉高压的诊断和评估

肺动脉高压（pulmonary hypertension，PH）评估的目的是确定疾病的严重程度、血液动力学病变的本质和后果、病因诊断及伴随的症状。对有临床症状和胸部X线提示PH表现者，要详细地询问病史和细致的体检，而对病因和严重程度的评估可通过超声心动图、能气／血流扫描、胸部CT、肺功能检查、夜间血氧监测来完成。对超声心动图显示中度至严重PH和准备实施治疗者，要进行右心导管插管测定肺动脉压力。对处于发生PH危险因素的患者，要给予超声心动和肺功能检查，从而对PH的发展和预后进行评估。不推荐用基因检测对原发性PH常规评估。     

超声检查在肺动脉高压诊疗中可靠性的Meta-分析

目的:综合评价超声检查在肺动脉高压(PAH)诊疗过程中的可靠性。方法:在数据库PubMed(1966年1月至2006年5月),Embase(1980年至2006年),中国期刊网(1978年1月至2006年5月)中,检索以PAH为研究对象,应用超声检查和右心导管检查,评价患者的血流动力学状态,对二种方法所测得的肺动脉收缩压进行比较的临床研究,对超声检查在PAH诊疗过程中的可靠性进行Meta-分析。结果:1.共有8项研究进行了超声检查结果与右心导管检查结果相关性分析,入选PAH患者256例。二者具有良好的相关性,合并后的R值为0.679,95%可信区间为0.623～0.735。2.共有6项研究对超声检查和右心导管检查进行了肺动脉收缩压测量值的比较,超声检查的结果明显低估了右心导管的结果;对其中48h内完成二种检查的2项研究进行综合比较,发现超声检查的结果仍低于右心导管检查结果,但二者差异的显著性降低。结论:在PAH的诊疗过程中超声检查的结果低估了肺动脉收缩压但可以反映其变化趋势。     

超声心动图在肺动脉高压患者右心功能评估中的应用进展

肺动脉高压是一种以呼吸困难、胸痛等为主要临床症状的常见病,其诊断及治疗困难,预后极差,患者多因右心衰竭死亡。因此,右心功能在一定程度上决定了肺动脉高压患者的危险分层、生存状况及预后。近年来随着超声心动图技术发展,其评估右心室功能的准确性不断提高,且其能够对右心疾病患者进行危险分层及提供预后信息。本文主要综述了超声心动图在肺动脉高压患者右心功能评估中的应用进展。     

右心导管检查在肺动脉高压中的应用

右心导管(RHC)检查作为一种微创检查方法,是诊断肺动脉高压的金标准,也是进行鉴别诊断、评估病情和治疗效果的重要手段.然而,尽管RHC检查已广泛应用于肺动脉高压的诊治和临床研究中,但在临床中仍缺乏关于实施RHC检查的最佳实践指导,因此有必要进一步推进RHC检查标准化、规范化实施,以确保其在肺动脉高压临床实践中的最佳应用...     

The assessment of pulmonary arterial pressures in bronchopulmonary dysplasia by cardiac catheterization and M-mode echocardiography

Severe (Stage IV) bronchopulmonary dysplasia (BPD) has been associated with pulmonary hypertension and right heart failure, with a mortality rate of 39%. Recently, M-mode echocardiography has been used to measure right-sided systolic time intervals (the ratio of right ventricular pre-ejection period to ejection time; RVPEP/RVET), with a value greater than 0.35 predicting pulmonary hypertension. This measurement has also been used to predict outcome of BPD and response to oxygen therapy. A retrospective study of six infants with Stage IV BPD who had had cardiac catheterizations and M-mode echocardiography is reported. By catheterization criteria, four of the six had pulmonary hypertension. By echocardiographic criteria, only two of the six had unequivocally prolonged RVPEP/RVET ratios, and correlations with mean or diastolic pulmonary arterial pressures were poor (0.069 and 0.255, respectively). The validity of M-mode echocardiography in the assessment of the pulmonary vascular bed in Stage IV BPD is open to debate, and its role in predicting outcome and response to therapy is unknown.     

REVEAL Registry: correlation of right heart catheterization and echocardiography in patients with pulmonary arterial hypertension

Cardiopulmonary hemodynamics are estimated by Doppler echocardiogram (ECHO) and measured by right heart catheterization (RHC) in patients with pulmonary arterial hypertension (PAH). Whether there is a correlation between these measurements is controversial. The authors investigated ECHO and RHC in patients enrolled in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL), a multicenter, observational, US-based study designed to provide current information about patients with PAH. Patients with PAH who had an ECHO and RHC within 12 months of each other were included. Correlation between subsequent ECHO and RHC was also investigated. Of 2967 patients, 2838 were 18 years and older at enrollment and 1883 had an RHC within 12 months of an ECHO. Correlations between ECHO-estimated and RHC-measured pulmonary artery systolic pressures (PASPs) and mean right atrial pressures did not change based on temporal proximity of the two baseline studies, whether they occurred on the same day or were separated by up to 12 months. In contrast, there was little correlation of serial measurements between ECHO and RHC. Although there is good correlation in PASP between ECHO and RHC at baseline, repeat ECHO measurements alone are not sufficient to monitor change in PASP or progression of PAH.     

肺动脉高压患者血浆肾上腺髓质素水平与肺动脉压力的关系

目的探讨肺动脉高压(pulmonary hypertension，PH)患者血浆肾上腺髓质素(adrenomedullin，AM)的浓度与肺动脉压力的关系。方法选择正常肺动脉压力患者和轻度、中度、重度肺动脉高压患者各10例，在术中分别从肺动脉和肺静脉中抽血用放射免疫法测定AM含量。结果肺动脉血浆AM浓度与肺动脉压力呈显著正相关；肺静脉血浆AM浓度低于肺动脉AM浓度，且其浓度差值与肺动脉压力呈显著正相关。结论AM参与了肺动脉高压的病理生理过程，并在肺内部分代谢，对肺血管张力的调节起重要作用。     

Failure of resting echocardiography and cardiac catheterization to identify pulmonary hypertension in two patients with type I Gaucher disease

Pulmonary hypertension (PHT) is a complication of Gaucher disease. Screening with echocardiography is recommended for Gaucher patients. Two patients naive to enzyme replacement therapy are presented in whom resting echocardiography revealed no evidence of PHT. One of the patients also had normal pulmonary artery pressures at cardiac catheterization. The diagnosis of PHT was made with open lung biopsy in one patient and dobutamine echocardiography in the other. In both cases, diagnosis of PHT altered patient management. Resting echocardiographic assessment may fail to identify PHT in patients with Gaucher disease.     

肺动脉高压患者血浆肾上腺髓质素水平与肺动脉压力的关系

目的：探讨肺动脉高压（pulmonary hypertension,PH)患者血浆肾上腺髓质素（a-drenomedullin,AM)的浓度与肺动脉压力的关系。方法：选择正常肺动脉压力患者和轻度、中度、重度肺动脉高压患者各10例，在术中分别从肺动脉和肺静脉中抽血用放射免疫法测定AM含量。结果：肺动脉血浆AM浓度与肺动脉压力呈显著正相关；肺静脉血浆AM浓度低于肺动脉AM浓度，且其浓度差值与肺动脉压力呈显著正相关。结论：AM参与了肺动脉高压的病理生理过程，并在肺内部分代谢，对肺血管张力的调节起重要作用。     

Correlation between cardiac catheterization and echocardiography in assessing the severity of mitral stenosis

During a 12-mth period 162 consecutive patients with mitral stenosis underwent examination by M-mode as well as cross-sectional echocardiography. The mitral valve area was measured by cross-sectional echocardiography and the severity of mitral stenosis by M-mode echocardiography. Out of the total, 69 patients underwent left and right heart catheterization and in 53 of these the mitral valve area was calculated. A correlation of r = 0.92 for the mitral valve area was found between sector scan echocardiography and cardiac catheterization, whereas the correlation between M-mode echocardiography and catheterization yielded a result of only r = 0.38.Thus the assessment of the severity of mitral stenosis by cross-sectional echocardiography is a reliable alternative to cardiac catheterization.