背景:对RV流出道多普勒模式的评估提供了对慢性血栓栓塞性肺动脉高压(CTEPH)的血流动力学的见解。我们研究了通过多普勒超声心动图在术前评估肺血流收缩切迹的时机是否与CTEPH肺内膜切除术(PEA)后的长期生存有关。
方法:61例连续CETPH患者中有59例(平均年龄53±14岁,研究了2002年6月至2005年6月期间接受PEA的34%男性)。临床,术前评估超声心动图和血流动力学变量,并在PEA后3个月进行重复超声心动图检查。用脉冲多普勒评估缺口比(NR),并计算为从肺血流开始到缺口的时间除以从缺口到肺血流结束的时间。2021年5月至2022年2月期间获得了长期随访。
结果:术前平均肺动脉压(mPAP)为45±15mmHg,肺血管阻力(PVR)为646±454dynes.s.cm-5。PEA前超声心动图显示7例患者无切口,33的NR<1.0,19的NR>1.0。PEA后三个月,超声心动图显示,NR<1.0和NR>1.0的长期存活者sPAP显著降低,而仅NR<1.0组TAPSE/sPAP显著升高.平均长期临床随访为14±6年。幸存者和非幸存者的NR有显着差异(0.73±0.25vs.1.1±0.44,p<0.001),但在mPAP或PVR中没有观察到显着差异。与NR>1.0的患者相比,NR<1.0的患者在14年时的长期生存率明显更好(83%vs.37%,p=<0.001)。
结论:术前评估NR是接受PEA的CTEPH患者长期生存的预测因子,NR<1.0的患者死亡率低。NR<1.0和NR>1.0的长期幸存者在PEA后sPAP显著降低。然而,NR<1.0组TAPSE/sPAP显著升高。在NR<1.0组中,在术前和术后1年随访时,6分钟步行试验显著增加.NR是一个简单的超声心动图参数,可用于PEA的临床决策。
BACKGROUND: Assessment of the pattern of the RV outflow tract Doppler provides insights into the hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH). We studied whether pre-operative assessment of timing of the pulmonary flow systolic notch by Doppler echocardiography is associated with long-term survival after pulmonary endarterectomy (PEA) for CTEPH.
METHODS: Fifty-nine out of 61 consecutive CETPH patients (mean age 53 ± 14 years, 34% male) whom underwent PEA between June 2002 and June 2005 were studied. Clinical, echocardiographic and hemodynamic variables were assessed pre-operatively and repeat echocardiography was performed 3 months after PEA. Notch ratio (NR) was assessed with pulsed Doppler and calculated as the time from onset of pulmonary flow until notch divided by the time from notch until end of pulmonary flow. Long-term follow-up was obtained between May 2021 and February 2022.
RESULTS: Pre-operative mean pulmonary artery pressure (mPAP) was 45 ± 15 mmHg and pulmonary vascular resistance (PVR) was 646 ± 454 dynes.s.cm-5. Echocardiography before PEA showed that 7 patients had no notch, 33 had a NR < 1.0 and 19 had a NR > 1.0. Three months after PEA, echocardiography revealed a significant decrease in sPAP in long-term survivors with a NR < 1.0 and a NR > 1.0, while a significant increase in TAPSE/sPAP was only observed in the NR < 1.0 group. Mean long-term clinical follow-up was 14 ± 6 years. NR was significantly different between survivors and non-survivors (0.73 ± 0.25 vs. 1.1 ± 0.44, p < 0.001) but no significant differences were observed in mPAP or PVR. Long-term survival at 14 years was significantly better in patients with a NR < 1.0 compared to patients with a NR > 1.0 (83% vs. 37%, p = < 0.001).
CONCLUSIONS: Pre-operative assessment of NR is a predictor of long-term survival in CTEPH patients undergoing PEA, with low mortality risk in patients with NR < 1.0. Long-term survivors with a NR < 1.0 and NR > 1.0 had a significant decrease in sPAP after PEA. However, the TAPSE/sPAP only significantly increased in the NR < 1.0 group. In the NR < 1.0 group, the 6-min walk test increased significantly between pre-operative and at 1-year post-operative follow-up. NR is a simple echocardiographic parameter that can be used in clinical decision-making for PEA.