Evaluation of pulmonary arterial hypertension with simple congenital heart disease using tissue Doppler imaging / 中华超声影像学杂志

ABSTRACT

Objective To evaluate the value of tissue Doppler imaging (TDI) in diagnosing pulmonary arterial hypertension(PAH) with common simple congenital heart disease(CHD).Methods 104 patients of CHD approved by operation or intervention were retrospectively analyzed.Both TDI and right cardiac catheterization were performed in all patients,whose were divided into PAH and non-PAH groups according to mean pulmonary arterial pressure (mPAP) on diagnostic right cardiac catheterization60 PAH patients[mPAP ≥25 mmHg(1 mmHg =0.133 kPa) and pulmonary arterial capillary wedge pressure ≤15 mmHg],44 non-PAH patients (mPAP ＜25 mmHg).The PAH group was divided into mild (25 mmHg≤ mPAP≤35 mmHg),moderate (36 mmHg≤mPAP≤50 mmHg) and severe (mPAP＞50 mmHg) subgroups.The tricuspid annular systolic peak velocity (TS'),early diastolic peak velocity (TE'),late diastolic peak velocity (TA') were measured by TDI and TE'/TA' and Tei index were calculated.The correlation between TDI parameters and the cardiac catheterization findings (sPAP,mPAP and dPAP) were assessed.Results ①TS' and TE' in PAH group were significantly lower than those in non-PAH(P ＜ 0.05),but Tei in PAH group were significantly higher than that in non-PAH (P ＜0.001),however,there were no significant difference in TA' and TE'/TA' between two groups (P ＞ 0.05).②Tei correlated positively with pulmonary arterial pressure (P ＜0.001),TS' was found to be negatively correlated with pulmonary arterial pressure(P ＜0.05),but no correlation between TE',TA',TE'/TA' and pulmonary arterial pressure(P ＞0.05).③ROC analysis showed the area under curves for Tei index and TS' diagnosis for PAH was 0.893 and 0.699,respectively.At the cutoff of Tei＞0.49 and TS'＜16 cm/s for indicating PAH,the sensitivity were 86.67 ％ and 80.00％,respectively and the specificity were 79.55 ％ and 45.45 ％,respectively.④Tei in the moderate and severe PAH were significantly higher than that in mild PAH (P ＜ 0.05),TS' and TE' in severe PAH were significantly lower than those in mild and moderate PAH (P ＜ 0.05),At the cutoff of Tei＞0.55 for indicating moderate or severe PAH,the sensitivity and specificity were 95.24％ and 72.22％.Conclusions Tei index and TS' have high application value in assessing PAH and classification of PAH.Tei＞0.49 indicates PAH,while Tei＞0.55 suggests moderate or severe PAH.