| 冯克福,储莉,王德超,王月平,闻伟,马礼坤.射血分数保留左心疾病相关肺动脉高压患者的临床特征和危险因素分析[J].中国临床保健杂志,2023,26(4):522-527. |
| 射血分数保留左心疾病相关肺动脉高压患者的临床特征和危险因素分析 |
| Clinical features and risk factors in patients with left heart disease associated pulmonary hypertension with preserved ejection fraction |
| 投稿时间：2023-05-11 |
| DOI：10.3969/J.issn.1672-6790.2023.04.020 |
| 中文关键词: 肺动脉高压 心脏病 每搏输出量 体征和症状 危险因素 |
| 英文关键词: Pulmonary arterial hypertension Heart diseases Stroke volume Signs and symptoms Risk factors 〖FL |
| 基金项目:国家自然科学基金面上项目(82170263) |
| 作者 | 单位 | E-mail | | 冯克福 | 中国科学技术大学附属第一医院安徽省立医院, 心血管内科,,合肥 230001 | lkma@ustc.edu.cn | | 储莉 | 中国科学技术大学附属第一医院安徽省立医院, 心血管内科,,合肥 230001 | lkma@ustc.edu.cn | | 王德超 | 中国科学技术大学附属第一医院安徽省立医院超声心动图室,合肥 230001 | lkma@ustc.edu.cn | | 王月平 | 中国科学技术大学附属第一医院安徽省立医院, 心血管内科,,合肥 230001 | lkma@ustc.edu.cn | | 闻伟 | 中国科学技术大学附属第一医院安徽省立医院, 心血管内科,,合肥 230001 | lkma@ustc.edu.cn | | 马礼坤 | 中国科学技术大学附属第一医院安徽省立医院, 心血管内科,,合肥 230001 | lkma@ustc.edu.cn |
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| 中文摘要: |
| 目的 分析射血分数保留左心疾病相关肺动脉高压(PH-HFpEF)患者的临床特征和危险因素,评价应用超声心动图和临床特征对PH-HFpEF患者的诊断价值。方法 连续收集中国科学技术大学附属第一医院(安徽省立医院)心血管内科2021年1月至2022年12月接受右心导管检查249例患者的病历资料,其中动脉性肺动脉高压患者41例(PAH组),PH-HFpEF患者39例(PH-HFpEF组),收集2组患者临床特征、超声心动图和右心导管检查(RHC)资料,对超声心动图检测的肺动脉收缩压(Echo-sPAP)与右心导管检测的肺动脉收缩压(RHC-sPAP)进行t检验和Pearson相关性分析；采用单因素和多因素logistic回归分析2组患者临床特征和超声心动图检查资料,确定诊断PH-HFpEF的临床因素和超声心动图指标；采用受试者工作曲线计算截断值,并计算灵敏度和特异度。结果 Echo-sPAP与RHC-sPAP呈显著正相关(r=0.794,P<0.001)；单因素和多因素logistic回归分析显示,左心房前后内径(LAD)和心血管疾病危险因素是诊断PH-HFpEF的独立预测因素,受试者工作特征曲线结果显示,LAD预测PH-HFpEF最佳截定值为41.5 mm,曲线下面积为0.945；以LAD 41.5 mm作为最佳截定值,联合心血管疾病危险因素和LAD>41.5 mm诊断PH-HFpEF的敏感度和特异度分别为94.87%和97.44%。结论 Echo-sPAP和RHC-sPAP具有良好相关性,LAD>41.5 mm和心血管疾病危险因素的联合使用有助于PH-HFpEF患者的诊断。 |
| 英文摘要: |
| Objective To analyze the clinical features and risk factors of patients with left heart disease-associated pulmonary hypertension with ejection fraction preservation (PH-HFpEF),and to evaluate the diagnostic value of echocardiography and clinical features in patients with PH-HFpEF with ejection fraction preservation.Methods A total of 249 patients who received right heart catheterization from January 2021 to December 2022 in the Department of Cardiovascular Medicine of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) were enrolled,including 41 patients with arterial pulmonary hypertension (PAH group) and 39 patients with PH-HFpEF (PH-HFpEF group).The clinical characteristics,echocardiography and right cardiac catheterization data of the two groups were collected.Paired t-test and pearson correlation analysis were performed for the pulmonary artery systolic pressure (Echo-sPAP) detected by echocardiography and the pulmonary artery systolic pressure (RHC-sPAP) detected by right cardiac catheter.Univariate and multivariate logistic regression were used to analyze the clinical characteristics and echocardiography data of the two groups patients,and to determine the clinical factors and echocardiographic indicators for the diagnosis of PH-HFpEF.Cut-off values were calculated by receiver operating characteristic (ROC) curve,and sensitivity and specificity were calculated.Results Echo-sPAP was positively correlated with RHC-sPAP (r=0.794,P<0.001).Univariate and multivariate logistic regression analysis showed that the anterior and posterior diameter of left atrial (LAD) and cardiovascular risk factors were independent predictors of the diagnosis of PH-HFpEF.ROC curve results showed that the optimal cut-off value predicted by LAD was 41.5 mm and the area under the curve was 0.945.The sensitivity and specificity diagnosing PH-HFpEF patients by combining cardiovascular disease risk factors and LAD>41.5 mm were 94.87% and 97.44%,respectively.Conclusions Echo-sPAP and RHC-sPAP have a good correlation.The combination of LAD>41.5 mm and cardiovascular risk factors is helpful in the diagnosis of patients with PH-HFpEF. |
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