From the Academic Department of Radiology, Academic Unit of Radiology, Department of Infection, Immunity & Cardiovascular Disease, Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T., D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C., D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals, Sheffield, England; and Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, England (A.J.S.).
Radiology. 2018 Oct;289(1):61-68. doi: 10.1148/radiol.2018180120. Epub 2018 Jul 3.
Purpose To assess interventricular septal (IVS) angle in the identification of combined pre- and postcapillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension (PH) due to left-sided heart disease. Materials and Methods In this retrospective study, consecutive, incident patients suspected of having PH underwent same-day right-sided heart catheterization (RHC) and MRI at a PH referral center between April 2012 and April 2017. The diagnostic accuracy of the IVS angle to identify Cpc-PH in patients with pulmonary arterial wedge pressure (PAWP) greater than 15 mmHg was assessed by using receiver operator characteristic curves, sensitivity, specificity, and negative and positive predictive values. IVS angle also was assessed as a predictor of all-cause mortality by using Cox uni- and multivariable proportional hazards regression. Results A total of 708 patients underwent same-day MRI and RHC, and 171 patients had PAWP greater than 15 mmHg. Mean age was 70 years (range, 21-90 years) (women: mean age, 69 years; range, 21-88 years) (men: mean age, 71 years; range, 43-90 years). Systolic IVS angle correlated with diastolic pulmonary gradient (DPG) (r = 0.739, P < .001). Receiver operating characteristic curve analysis showed septal angle enabled identification of Cpc-PH (DPG ≥ 7), with an area under the receiver operating characteristic curve of 0.911 (P < .001). A 160° threshold, derived from the first half of patients with raised PAWP, enabled identification of a DPG of at least 7 mmHg with 67% sensitivity and 93% specificity (P < .001) in the second cohort of patients with raised PAWP. IVS angle was predictive of all-cause mortality (standardized univariable hazard ratio, 1.615; P < .01). Conclusion The systolic interventricular septal angle is elevated in patients with combined pre- and postcapillary pulmonary hypertension and enables one to predict those patients who have PH due to left-sided heart disease who have an increased risk of death. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
目的 评估室间隔角（IVS）在识别因左心疾病导致肺动脉高压（PH）患者的毛细血管前和毛细血管后肺动脉高压（Cpc-PH）中的作用。
材料与方法 在这项回顾性研究中，于 2012 年 4 月至 2017 年 4 月期间，在 PH 转诊中心，对连续出现的疑似 PH 且肺动脉楔压（PAWP）＞15mmHg 的患者进行了同日右心导管检查（RHC）和 MRI。使用受试者工作特征曲线、灵敏度、特异性、阴性和阳性预测值评估 IVS 角度识别 PAWP＞15mmHg 的患者中 Cpc-PH 的诊断准确性。还使用 Cox 单变量和多变量比例风险回归评估 IVS 角度作为全因死亡率的预测因子。
结果 共有 708 例患者同日进行了 MRI 和 RHC，171 例患者的 PAWP＞15mmHg。平均年龄为 70 岁（范围，21-90 岁）（女性：平均年龄，69 岁；范围，21-88 岁）（男性：平均年龄，71 岁；范围，43-90 岁）。收缩期 IVS 角度与舒张性肺梯度（DPG）相关（r=0.739，P＜.001）。受试者工作特征曲线分析表明，室间隔角度能够识别 Cpc-PH（DPG≥7），其受试者工作特征曲线下面积为 0.911（P＜.001）。从 PAWP 升高的患者前半部分中得出的 160°阈值，可使 DPG 至少为 7mmHg，在 PAWP 升高的第二组患者中，灵敏度为 67%，特异性为 93%（P＜.001）。IVS 角度可预测全因死亡率（标准化单变量危险比，1.615；P＜.01）。
结论 在合并毛细血管前和毛细血管后肺动脉高压的患者中，收缩期室间隔角升高，可预测因左心疾病导致 PH 的患者中存在死亡风险增加的患者。
发表于 CC BY 4.0 许可证下。本文的在线补充材料可在网上获取。
