Department of Biomedical, Chemical and Materials Engineering, San Jose State University , San Jose, California.
Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin.
J Appl Physiol (1985). 2018 Feb 1;124(2):283-290. doi: 10.1152/japplphysiol.00258.2017. Epub 2017 Oct 12.
Clinical assessment of right ventricular (RV) contractility in diseases such as pulmonary arterial hypertension (PAH) has been hindered by the lack of a robust methodology. Here, a novel, clinically viable, single-beat method was developed to assess end-systolic elastance (E), a measure of right ventricular (RV) contractility. We hypothesized that this novel approach reduces uncertainty and interobserver variability in the estimation of the maximum isovolumic pressure (P), the key step in single-beat methods. The new method was designed to include a larger portion of the RV pressure data and minimize subjective adjustments by the operator. Data were obtained from right heart catheterization of PAH patients in a multicenter prospective study ( data set 1) and a single-center retrospective study ( data set 2). To obtain P, three independent observers used an established single-beat method (based on the first derivative of the pressure waveform) and the novel method (based on the second derivative). Interobserver variability analysis included paired t-test, one-way ANOVA, interclass correlation (ICC) analysis, and a modified Bland-Altman analysis. The P values obtained from the two methods were linearly correlated for both data set 1 ( R = 0.74) and data set 2 ( R = 0.91). Compared with the established method, the novel method resulted in smaller interobserver variability ( P < 0.001), nonsignificant differences between observers, and a narrower confidence interval. By reducing uncertainty and interobserved variability, this novel approach may pave the way for more effective clinical management of PAH. NEW & NOTEWORTHY A novel methodology to assess right ventricular contractility from clinical data is demonstrated. This approach significantly reduces interobserver variability in the analysis of ventricular pressure data, as demonstrated in a relatively large population of subjects with pulmonary hypertension. This study may enable more accurate clinical monitoring of systolic function in subjects with pulmonary hypertension.
在肺动脉高压（PAH）等疾病中，右心室（RV）收缩功能的临床评估受到缺乏稳健方法的阻碍。在这里，开发了一种新颖的、临床可行的单拍方法来评估收缩末期弹性（E），这是评估右心室（RV）收缩功能的一个指标。我们假设这种新方法可以减少在估计单拍方法的关键步骤——最大等容压力（P）时的不确定性和观察者间的变异性。新方法旨在包括 RV 压力数据的更大部分，并通过操作者的主观调整最小化。数据来自多中心前瞻性研究（数据集 1）和单中心回顾性研究（数据集 2）的 PAH 患者的右心导管检查。为了获得 P，三位独立观察者使用了一种已建立的单拍方法（基于压力波形的一阶导数）和新方法（基于二阶导数）。观察者间变异性分析包括配对 t 检验、单因素方差分析、组内相关系数（ICC）分析和改良的 Bland-Altman 分析。两种方法获得的 P 值在数据集 1（ R = 0.74）和数据集 2（ R = 0.91）中均呈线性相关。与已建立的方法相比，新方法导致观察者间变异性更小（ P < 0.001），观察者之间无显著差异，置信区间更窄。通过减少不确定性和观测间变异性，这种新方法可能为 PAH 的更有效临床管理铺平道路。 本研究展示了一种从临床数据评估右心室收缩力的新方法。该方法在相当大的肺动脉高压患者人群中显著降低了心室压力数据分析中的观察者间变异性。这项研究可能使肺动脉高压患者的收缩功能的临床监测更加准确。
