运动时肺动脉压的无创评估:右心房高血压摩根富林明的重要性——欧洲呼吸杂志》乔和J - 10.1183/13993003.01617 -2019欧元六世- 55 - 2 SP - 1901617 AU Obokata Masaru AU -凯恩Garvan c . AU - Sorimachi Hidemi AU - Reddy,尤喷嘴速度非盟-奥尔森,Thomas p . AU - Egbe,亚历山大•c . AU - Melenovsky Vojtech AU -博洛格,【摘要】N2 -引言在运动过程中识别肺动脉高压具有重要的诊断、预后和治疗意义。在运动测试中，压力超声心动图常被用来估计肺动脉压力，但支持这种做法的数据是有限的。本研究探讨多普勒超声心动图在评估肺动脉压力方面的准确性。方法对97例呼吸困难患者在休息和运动时同时进行心导管检查和超声心动图检查。超声心动图测定肺动脉收缩压(ePASP)，计算从右心室(RV)到右心房(RA)的压力梯度和估计的RA压力(eRAP)，并与直接测量的PASP和RAP进行比较。结果估计有57%的受试者在休息时可以获得PASP，但在运动期间可行性下降到15-16%，主要是由于在压力下无法获得eRAP。预估PASP与静息时直接PASP相关性良好(r=0.76, p<0.0001;偏倚- 1毫米汞柱)和运动期间(r=0.76, p=0.001;偏差+ 3毫米汞柱)。 When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (−14–25 mmHg).Conclusions The RV–RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures.This study shows that the right atrial component of the estimated pulmonary artery pressure equation is often overlooked, but quite important, and failure to account for this leads to substantial underestimation of the severity of exercise-induced PH http://bit.ly/32xgKTD ER -