| Objective: To investigate the association of echocardiography and echocardiogram(ECG) parameters with pulmonary arterial hemodynamic parameters detected by right heart catheterization(RHC), and to assess the predictive value of echocardiography, ECG and echocardiography combined ECG on left to right shunt congenital heart disease(CHD) associated pulmonary hypertension(PAH).Methods: 110 cases of left to right shunt CHD with PAH(PAH-CHD) and 123 cases of left to right shunt CHD without PAH, including atrial septal defect(ASD, n=113), ventricular septal defect(VSD, n=36) and patent ductus arteriosus(PDA, n=84) were diagnosed by RHC in Fujian Provincial Hospital, Fujian Medical University Union Hospital and the First Affiliated Hospital of Fujian Medical University from January 2008 to May 2015 were included in this study. Echocardiography and ECG parameters were compared between PAH and non-PAH patients and the correlation of those with hemodynamic parameters were analyzed. Comparison of normal distribution and non-normal distribution quantitative data was used to test and Chi test respectively. Spearman correlation analysis was used to analyze the association among the variables. The receiver operative characteristic(ROC) curve was used to assess the predictive value of echocardiography, ECG and echocardiography combined with ECG on left to right shunt PAH-CHD.Results: 1.Pulmonary arterial systolic pressure(PASP) estimated by echocardiography in PAH group was higher than no-PAH group(P<0.05), and it had higher correlation with most of parameters detected by RHC(P<0.05). ROC curve analysis demonstrated that PASP had high sensitivity and specificity to predict PAH-CHD PASP>42.5 mm Hg has a sensitivity of 73.6% and a specificity of 75.6% for prediction of PAH in all patients with CHD.2.There are significant differences in RAd, LVDd and LVDd/RVd between in the PAH group and in the non-PAH group in all patients with CHD(P<0.05), while no significant difference in RVd and PA. Futuremore, Among patients with VSD, LVDd in the PAH group is increased in comparison to that in the non-PAH group(P<0.05). Among patients with PDA, LVDd in PAH group have an increasing trend than that in non-PAH group, but there is no significant difference, whereas LVDd/RVd in PAH is higher than non-PAH(P<0.05),suggesting that proportion of left and right ventricular internal dimension was abnormally altered. Among patients with ASD,RVDd and PA in PAH were higher than non-PAH(P<0.05).3. QTc in PAH was longer than non-PAH(P<0.05). Compared to non-PAH,RV5, SV1, RV5+SV1 amplitudes were increased in ASD,VSD,PDA and all patients with CHD(P<0.05). Spearman correlation analysis showed that mean pulmonary arterial pressure(mPAP) in ASD was positively correlated with Rand R+Samplitude(P<0.05).However, There is no correlation of m PAP in ASD with RV5 amplitude and RV5+SV1. Among all patients with CHD,cardiac axis of QRS, RV1 amplitude, SV1 amplitude, RV5 amplitude, RV1+SV5, RV5+SV1, RV1 amplitude×interval, SV1 amplitude×interval, RV5 amplitude×interval were analyzed by ROC curve to predict PAH and area under the curve of these parameters was higher than 0.500(P<0.05),while sensitivity and specificity are low.4.Using combination of PASP, LVDd/RVd, RV5 amplitude×interval to predict PAH,the sensitivity of diagnosis of PAH in all patients with CHD,ASD and VSD combined PDA were 75.0%,74.4%and 74.1%, and the specificity were 79.3%、82.4%and 89.4%, respectively. The sensitivity and specificity of this combination is higher than PASP alone.Conclusions: 1. Echocardiography has a favorable predictive value in the diagnosis of left to right shunt PAH-CHD.2. LVDd and LVDd/RVd have some predictive value in the diagnosis of left to right shunt PAH-CHD.3. ECG has a limited value in the diagnosis of left to right shunt PAH-CHD.4. Combination of echocardiography and ECG parameters could enhance the predictive value in the diagnosis of left to right shunt PAH-CHD. |
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