ePLAR ‿The echocardiographic Pulmonary to Left Atrial Ratio ‿A novel non-invasive parameter to differentiate pre-capillary and post-capillary pulmonary hypertension

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• 作者：Gregory M. Scalia^a ; ^b ; ^c ; ^d ; ^{gmscalia@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Isabel G. Scalia^d ; Rebecca Kierle^b ; Rebekka Beaumont^c ; David B. Cross^b ; ^c ; John Feenstra^c ; Darryl J. Burstow^a ; ^d ; Benjamin T. Fitzgerald^a ; ^b ; ^c ; David G. Platts^a
• 关键词：ePLAR ; echocardiographic Pulmonary to Left Atrial Ratio ; PHT ; pulmonary hypertension ; RHC ; right heart catheterisation ; PAP ; pulmonary artery pressure ; LAP ; left atrial pressure ; TRVmax ; tricuspid valve continuous wave maximum Doppler velocity ; RVSP ; right ventricular systolic pressure ; TPG ; trans-pulmonary gradient ; DPG ; diastolic pressure gradient ; PVR ; pulmonary vascular resistance ; PCWP ; pulmonary capillary wedge pressure ; E/e&prime ; transmitral pulsed-wave Doppler early diastolic wave divi
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 June 2016
• 年：2016
• 卷：212
• 期：Complete
• 页码：379-386
• 全文大小：1280 K

文摘

Right heart catheterisation is the gold-standard for differentiating pre-capillary pulmonary hypertension (high mean pulmonary artery pressure, normal pulmonary wedge pressure) from post-capillary physiology (elevated pulmonary wedge pressure). The new non-invasive parameter, ePLAR (echocardiographic Pulmonary to Left Atrial Ratio) is calculated from the maximum tricuspid regurgitation continuous wave Doppler velocity (m/s) divided by the transmitral E-wave:septal mitral annular Doppler Tissue Imaging e′-wave ratio (TRV_max/E:e′).

Methods

Pulmonary hypertension patients (mean pulmonary artery pressure > 25 mm Hg, n = 133, 66 male, average 65.0 ± 16.8 years) were classified by right heart catheterisation as pre-capillary or post-capillary [subdivided into isolated post-capillary (diastolic pulmonary gradient < 7 mm Hg) or combined pre- and post-capillary cases]. The ePLAR values of these groups were compared to each other and to a population sample of 16,356 population reference echocardiograms.

Results

ePLAR values for the normal reference population of 16,356 echocardiograms (age 56 ± 16.6 years) were 0.30 ± 0.09 m/s. Pre-capillary pulmonary hypertension patients (n = 35, 26 male, PAP_sys 63.9 ± 16.6 mm Hg, PAP_diast 24.1 ± 7.3 mm Hg, PAP_mean 37.9 ± 9.4 mm Hg, PCWP 10.6 ± 2.7 mm Hg) had significantly higher ePLAR values than post-capillary cases (n = 98, 40 male, PAP_sys 59.9 ± 17.6 mm Hg, PAP_diast 25.0 ± 7.4 mm Hg, PAP_mean 38.1 ± 9.8 mm Hg, PCWP 23.5 ± 6.4 mm Hg) − ePLAR 0.44 ± 0.22 m/s vs 0.20 ± 0.11 m/s (p < 0.001). ePLAR values were significantly lower in isolated post-capillary pulmonary hypertension than in combined pre- and post-capillary cases (0.18 ± 0.08 m/s vs 0.28 ± 0.18 m/s, p < 0.001).

Conclusions

ePLAR is a simple echocardiographic parameter which can accurately differentiate the smaller subset of patients with pre-capillary pulmonary hypertension from the more common post-capillary aetiology. The use of this easily obtained echocardiographic parameter has the potential to enhance non-invasive triage of patients for specific pulmonary vasodilator therapy.