摘要：
Objective To investigate the correlation of pulmonary artery pressure assessment at different phases by continuous wave Doppler(CW) echocardiography and cardiac catheterization in patients with idiopathic pulmonary arterial hypertension(IPAH). Methods A total of 113 cases of patients suspicious of IPAH with symptoms of chest stuffy and pneumatic were enrolled in the study,the cardiac catheterization results was acquired as the gold standard. The efficacy of CW in the diagnosis of IPAH was investigated,meanwhile the pulmonary artery pressure detected by CW and cardiac catheterization was analyzed,and the correlation between conventional ultrasound index[main pulmonary artery diameter(MPA),right atrium transverse diameter(RAT),end-diastolic transverse diameter of both right and left ventricle(RVT,LVT),and axial diameter of both right and left ventricle(RVD,LVD),the ratio of transverse diameter between right ventricle and left ventricle(RVT/LVT),the ratio of axial diameter(RVD/LVD)] and pulmonary artery pressure detected by cardiac catheterization was analyzed. Results Among the 113 suspected IPAH cases , 78 cases of IPAH were confirmed by cardiac catheterization,68 cases were diagnosed by ultrasound,10 cases were missed diagnosis,and 9 cases were misdiagnosed. The sensitivity,specificity,positive predictive value, negative predictive values and accuracy of continuous wave Doppler echocardiography were 87.2%,74.3%,88.3%,72.2% and 83.2%,respectively. The pulmonary artery systolic pressure(PASPe),pulmonary artery diastolic pressure(PADPe),pulmonary artery mean pressure(PAMPe) detected by CW and these indicators detected by cardiac catheterization as PASPc,PADPc and PAMPc were positively correlated significantly(r=0.667,0.639,0.636,all P<0.05). And MPA,RAT,RVT,RVD,RVT/LVT,RVD/LVD and PASPc were positively correlated significantly(r=0.283,0.471, 0.551,0.442, 0.593,0.489,all P<0.05). Conclusion There is significant correlation between the pulmonary artery pressure at different phases measured by CW and cardiac catheterization. Using CW to measure the tricuspid regurgitation and pulmonary valve regurgitation has a high accuracy in assessing pulmonary pressure,and it is the preferred method on the noninvasive assessment of pulmonary hypertension in patients with IPAH.%目的 探讨连续多普勒超声(CW)对特发性肺动脉高压(IPAH)患者不同时相肺动脉压与心导管检测肺动脉压之间的关联.方法 选取我院因胸闷、气促等临床可疑IPAH患者113例,以经心导管确诊为诊断金标准,计算CW对IPAH患者的诊断效能;分析CW检测肺动脉压指标与心导管检测肺动脉压指标,以及常规超声指标[主肺动脉内径(MPA)、右房左右径(RAT)、右、左心室舒张末期左右径(RVT、LVT)、前后径(RVD、LVD)、右、左心室左右径比值(RVT/LVT)及前后径比值(RVD/LVD)]与心导管所测肺动脉压的关系.结果 113例疑似IPAH患者中,心导管确诊78例,其中超声准确诊断68例,漏诊10例,误诊9例.CW估测肺动脉高压的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为87.2%、74.3%、88.3%、72.2%及83.2%.经CW检测IPAH患者的肺动脉收缩压(PASPe)、舒张压(PADPe)及平均压(PAMPe)与心导管检测的收缩压(PASPc)、舒张压(PADPc)及平均压(PAMPc)均呈正相关(r=0.667、0.639、0.636,均P<0.05);且MPA、RAT、RVT、RVD、RVT/LVT及RVD/LVD与PASPc均呈正相关(r=0.283、0.471、0.551、0.442、0.593、0.489,均P<0.05).结论 CW对IPAH患者不同时相肺动脉压的评估与心导管检测肺动脉压之间存在显著相关性;应用CW测量三尖瓣及肺动脉瓣反流对IPAH患者肺动脉压的评估具有较高的准确性,是无创评估肺动脉高压的首选方法.
