超声心动图与间接Fick法测定肺动脉高压心脏指数的相关分析

肖家旺; 黄帅; 庚靖淞; 孟立立; 王建铭; 王忠超; 赵明; 王琦光

doi:10.12125/j.chj.202212099

超声心动图与间接Fick法测定肺动脉高压心脏指数的相关分析

Correlation analysis of cardiac indexes using echocardiography and indirect Fick method in patients with pulmonary arterial hypertension

摘要

摘要:
目的比较超声心动图（Echo）与右心导管（RHC）测定肺动脉高压（PAH）患者心脏指数（CI）结果的相关性。
方法回顾性选取68例中国人民解放军北部战区总医院先心病内科确诊PAH患者，其中特发性PAH 22例，先天性心脏病术后PAH 42例，慢性血栓栓塞性肺动脉高压4例。所有患者均24 h内采用双平面Simpson法与间接Fick法测定心输出量并计算CI，并根据间接Fick法测定的CI结果将患者分为低心排出量组n=35，<2.5 L/（min×m²）和正常心排出量组n=33，≥2.5 L/（min×m²），分别进行总体及各组的相关分析与Bland-Altman一致性分析。再根据两种方法测定的CI值分别进行PAH危险分层。
结果 CI-Echo与CI-RHC的CI分别为（2.52 ± 0.56） L/（min×m²）与（2.49 ± 0.79） L/（min×m²），两组数据总体均数没有统计学差异。CI-Echo与CI-RHC呈显著正相关，总体：r=0.67，P<0.01，正常心排量： r=0.57，P<0.01，低心排量：r=0.48，P<0.01。正常心排出量组：CI-Echo为（2.82 ± 0.46） L/（min × m²），CI-RHC为（3.09 ± 0.54） L/（min × m²），差值（Echo-RHC）为（−0.27）± 0.51） L/（min × m²），95%置信区间（−0.45）～（−0.09），两组数据总体均数没有统计学差异。低心排出量组：CI-Echo为（2.24 ± 0.51） L/（min × m²），CI-RHC为（1.92 ± 0.37） L/（min × m²），差值（Echo-RHC）为（0.33 ± 0.43） L/（min × m²），95%置信区间（0.18～0.48），两组数据总体均数没有统计学差异。总体R²线性=0.452，正常心排量R²线性=0.267，低心排量R²线性=0.365。Bland-Altman图显示两种测量方法及其在不同CI分组中均具有良好的一致性。Echo与间接Fick法测定CI对PAH危险分层结果一致的比例为68%，若以RHC测定的CI为危险分层的参考标准，低危、中危、高危组的一致性比例分别为84.8%、52.9%、50%。
结论 PAH患者Echo双平面Simpson法与RHC间接Fick法测定的CI呈显著正相关，且一致性良好；两种方法测定的CI对PAH的危险分层结果一致性较好。

Abstract:
AIM To compare the correlation between echocardiography (Echo) and cardiac index (CI) results measured by right heart catheterization (RHC) in pulmonary arterial hypertension (PAH).
METHODS Sixty-eight patients with PAH were retrospectively selected from the Department of Congenital Heart Disease of the General Hospital of Northern Theater Command the Chinese People’s Liberation Army, including 22 patients with idiopathic PAH, 42 patients with postoperative PAH of congenital heart disease, and 4 patients with chronic thromboembolic pulmonary hypertension. All patients were measured cardiac output and calculated CI by biplane Simpson method and indirect Fick method within 24 hours. According to the CI results measured by indirect Fick method, the patients were divided into low cardiac output group n=35,<2.5 L/(min×m²) and normal cardiac output group n=33, ≥ 2.5 L/(min×m²), and the correlation analysis and Bland-Altman consistency analysis of the whole group and each group were carried out respectively. Then the risk stratification of PAH was carried out according to the CI values measured by the two methods.
RESULTS CI-Echo and CI-RHC were (2.52 ± 0.56) L/(min) respectively×m²) and (2.49 ± 0.79) L/(min×m²), there were no statistical difference between the two groups. CI-Echo was significantly positively correlated with CI-RHC. Overall: r=0.67, P<0.01; normal cardiac output: r=0.57, P<0.01; low cardiac output: r=0.48, P<0.01. Normal cardiac output group: CI-Echo is (2.82 ± 0.46) L/(min×m²), CI-RHC is (3.09 ± 0.54) L/(min×m²), the difference (Echo-RHC) was (−0.27) ± 0.51) L/(min×m²), 95% confidence interval (−0.45)～(−0.09), there were no statistical difference in the overall mean of the two groups of data. Low cardiac output group: CI-Echo was (2.24 ± 0.51) L/(min×m²), CI-RHC was (1.92 ± 0.37) L/(min×m²), the difference (Echo-RHC) was (0.33 ± 0.43) L/(min×m²), 95% confidence interval (0.18～0.48) , there were no statistical difference in the overall mean of the two groups of data. Overall R² linearity=0.452, normal cardiac displacement R² linearity=0.267, low cardiac displacement R² linearity=0.365. The Bland-Altman diagram showed that the two measurement methods and their good consistency in different CI groups. The proportion of consistency between Echo and indirect Fick method in determining CI for PAH risk stratification is 68%. If the CI measured by RHC is used as the reference standard for risk stratification, the consistency proportion of low risk, medium risk and high risk groups were 84.8%, 52.9% and 50% respectively.
CONCLUSION Echo biplane Simpson method and RHC indirect Fick method show a significant positive correlation and the results of risk stratification for PAH determined by both methods are fairly consistent.

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