经胸超声心动图估测肺动脉收缩压的准确性

Accuracy of pulmonary artery systolic pressure estimated by transthoracic echocardiography

摘要:

目的：评价经胸超声心动图（transthoracic echocardiography，TTE）通过三尖瓣反流压差法估测肺动脉收缩压（pulmonary arterial systolic pressure，PASP）的准确性。方法：回顾性分析重庆医科大学附属第一医院2015年10月至2016年11月住院的91例疑诊肺动脉高压（pulmonary hypertension，PH）患者，所有患者均先后进行了TTE和右心导管（right heart catheterization，RHC）检查，以RHC结果为诊断金标准，应用Pearson相关系数法分析2种检查方法的相关性，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，分析TTE估测PASP的准确性，同时确定其筛查PH的诊断临界值。结果：91例患者中，TTE确诊患者67例，确诊率73.6%。TTE和RHC所测的PASP分别为（73.63±23.96）、（52.91±3.07） mmHg，Pearson相关性分析显示两者呈中度相关（r=0.734，P=0.000）。ROC曲线下面积（AUC）为0.812（P=0.000），诊断准确性中等，确定的筛查PH临界值为PASP≥62.5 mmHg（灵敏度70%，特异性83%），高于目前国际推荐标准。结论：TTE通过三尖瓣反流压差法估测PASP可能并不准确，更易于高估患者的PASP。

Abstract:

Objective：To investigate the accuracy of pulmonary artery systolic pressure（PASP） estimated by transthoracic echocardiog－raphy（TTE） using tricuspid regurgitation pressure gradient measurements. Methods：A cohort of 91 patients who were hospitalized in the First Affiliated Hospital of Chongqing Medical University between October 2015 and December 2016 with suspected pulmonary hypertension（PH） were enrolled in the retrospective study. All the patients underwent TTE and right heart catheterization（RHC） ex－aminations. Setting the RHC results as the golden standard，the correlation between two examinations was evaluated using Pearson analytic method. The receiver operating characteristic（ROC） curve was drawn in order to analyze the accuracy of TTE and clarified its cut-off value for PH screening. Results：TTE confirmed 67 patients a diagnosis of PH with a diagnostic rate of 73.6%. The mean estimated PASP by TTE and RHC were （73.63±23.96） mmHg and （52.91±3.07） mmHg，respectively. Pearson correlation analysis showed that there was a moderate correlation between two methods（r=0.734，P=0.000）. Area under the ROC curve was 0.812（P=0.000），indicating the diagnosis accuracy was moderate. The cut-off value for diagnosis of PH was PASP≥62.5 mmHg （sensitivity：70%，specificity：83%） which was higher than current international standard. Conclusion：The evaluation of PASP estimated by TTE using tricuspid regurgitation pressure gradient measurements is inaccurate；it is more likely to overestimate the PASP.