超声心动图联合心电图对先天性心脏病相关性肺动脉高压的预测价值

发布时间：2018-06-03 17:36

本文选题：先天性心脏病 + 肺动脉高压　；参考：《中华高血压杂志》2017年08期

【摘要】：目的探讨超声心动图联合心电图对左向右分流型先天性心脏病相关性肺动脉高压(PAH-CHD)的预测价值。方法收集2008年1月至2015年8月期间在福建医科大学附属第一医院、协和医院及福建省立医院就诊的左向右分流型先天性心脏病(CHD)患者共233例,其中合并肺动脉高压(PAH)患者110例(PAH组),不合并PAH患者123例(非PAH组)。所有患者均行右心导管,参照2015年欧洲肺高压指南以肺动脉平均压(PAMP)≥25mm Hg作为诊断肺高压的依据。对比两组间超声心动图及心电图指标的差异,分析超声心动图、心电图指标预测PAH-CHD的准确性。结果与非PAH组相比,PAH组超声心动图测量的肺动脉收缩压(PASP_(echo))、右心房横径(RAd)、左心室舒张末期内径(LVDd)、左心室舒张末期内径与右心室横径之比(LVDd/RVd)、心电图S_(V1)振幅、R_(V5)振幅、R_(V5)+S_(V1)振幅绝对值、R_(V1)振幅乘时限、S_(V1)振幅乘时限、R_(V5)振幅乘时限增高或增大(均P0.05)。二元逐步Logistic回归分析结果显示PASP_(echo)、LVDd/RVd、R_(V5)振幅与时限乘积是右心导管测量的肺动脉平均压(PAMP_(rhc))的预测指标,超声心动图联合心电图预测PAH的联合指标(EE)=1/[1+e~(-(-6.289+0.086×PASP_(echo)+1.084×LVDd/RVd+0.006×R_(V5)振幅乘时限))]。EE和PASP_(echo)与右心导管测量的PAMP_(rhc)、肺动脉收缩压(PASP_(rhc))、肺动脉舒张压(PADP_(rhc))均显著相关。且EE与PAMP_(rhc)、PASP_(rhc)、PADP_(rhc)的相关性高于PASP_(echo)与此三者的相关性(相关系数分别为0.724比0.588、0.622比0.615、0.625比0.519,均P0.05)。与PASP_(echo)相比,EE预测PAH-CHD敏感度较高(75.0%比73.6%),特异度也较高(79.3%比75.6%)。结论超声心动图联合心电图可提高对左向右分流型PAH-CHD的预测价值,敏感度为75.0%,特异度为79.3%。
[Abstract]:Objective to investigate the predictive value of echocardiography combined with electrocardiogram on left to right shunt congenital heart disease associated pulmonary hypertension (PAH-CHD). Methods to collect left to right shunt congenital heart disease (CHD) in the First Affiliated Hospital of Fujian Medical University, Concorde hospital and Fujian Province-owned Hospital from January 2008 to August 2015. A total of 233 cases, of which 110 cases (group PAH) were combined with pulmonary arterial hypertension (PAH), and 123 cases (non PAH) were not combined with PAH patients. All patients underwent right cardiac catheterization. According to the European pulmonary hypertension guidelines in 2015, the average pressure of pulmonary artery (PAMP) > 25mm Hg was used as the basis for the diagnosis of pulmonary hypertension. The differences between the two groups of echocardiography and electrocardiogram were compared. The accuracy of PAH-CHD was predicted by echocardiography and electrocardiogram. Results compared with the non PAH group, the pulmonary systolic pressure (PASP_ (echo)), the right atrium transverse diameter (RAd), the left ventricular end diastolic diameter (LVDd), the ratio of the left ventricular end diastolic diameter to the right ventricular transverse diameter (LVDd/RVd), the amplitude of S_ (V1), R_ (V5) amplitude, and the amplitude of R_ (V5) were compared in group PAH (RAd). V5) +S_ (V1) amplitude absolute value, R_ (V1) amplitude multiplicative time limit, S_ (V1) amplitude multiplicative time limit, R_ (V5) amplitude multiplicative time limit or increase (P0.05). Two element stepwise Logistic regression analysis shows that the amplitude and time product is the prediction index of the mean pulmonary artery pressure measured by the right heart catheter. PAH (EE) =1/[1+e~ (- (-6.289+0.086 * PASP_ (echo) +1.084 x LVDd/RVd+0.006 x R_ (V5) amplitude multiplicative time limit) is predicted by electrocardiogram. The correlation was higher than the correlation between PASP_ (echo) and the three (the correlation coefficient was 0.724 to 0.588,0.622 compared to 0.615,0.625, P0.05). Compared with PASP_ (echo), EE predicted PAH-CHD sensitivity (75% to 73.6%) and higher specificity (79.3% than 75.6%). Conclusion echocardiographic combined electrocardiogram can improve left to right shunt PAH-CHD. The predictive value is 75%, and the specificity is 79.3%.
【作者单位】：福建医科大学附属第一医院干部病房福建省高血压研究所;厦门市第五医院;
【分类号】：R541.1

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