Ospedali Riuniti University Hospital.
Department of Medical & Surgical Sciences, University of Foggia, Foggia.
J Cardiovasc Med (Hagerstown). 2019 Dec;20(12):809-815. doi: 10.2459/JCM.0000000000000853.
Right heart catheterization (RHC) is recommended by guidelines for the diagnosis of pulmonary hypertension, the definition of hemodynamic impairment and responsiveness to drug therapy. However, RHC is an invasive test with associated risk of complications. Noninvasive echocardiographic tools, possibly predictive of pulmonary hypertension at RHC, could be therefore extremely useful.
Sixty-four consecutive patients with suspected pulmonary hypertension were enrolled in the study and assessed by echocardiography and RHC. Diagnosis of pulmonary hypertension was based on mean pulmonary artery pressure (≥25 mmHg) at RHC.
Of 64 consecutive patients enrolled, 77% were diagnosed as having pulmonary hypertension after RHC. On the basis of significant differences between patients with pulmonary hypertension at RHC and those without on echocardiographic assessment, a multiple logistic regression model was constructed to predict the presence of pulmonary hypertension at RHC. The score was calculated using right atrium and ventricular diastolic area, tricuspid regurgitation Vmax, tricuspid regurgitation severity degree and left ventricular ejection fraction. The score area under the curve was therefore 0.786 (P = 0.0001), higher than for tricuspid regurgitation Vmax (P = 0.06). A score value more than 57 was associated with a 93% sensitivity, a 67% specificity, a 91% positive predictive power, a 73% negative predictive power, and an odds ratio 27 (P < 0.001) of pulmonary hypertension at RHC, significant even after correction at multivariable analysis. Accuracy of the prediction model was assessed in a validation cohort with comparable results (P = n.s.).
A simple noninvasive echocardiographic score can be useful in predicting the diagnosis of pulmonary hypertension at RHC and may be considered for the selection of patients who should undergo or could avoid RHC.
右心导管检查（RHC）被指南推荐用于诊断肺动脉高压、确定血流动力学障碍以及评估药物治疗反应。然而，RHC 是一种有创性检查，存在并发症风险。因此，能够预测 RHC 时肺动脉高压的非侵入性超声心动图工具可能非常有用。
连续纳入 64 例疑似肺动脉高压患者，通过超声心动图和 RHC 进行评估。RHC 时平均肺动脉压（≥25mmHg）定义为肺动脉高压。
64 例连续患者中，77%在 RHC 后被诊断为肺动脉高压。根据 RHC 时存在肺动脉高压和不存在肺动脉高压患者在超声心动图评估方面的显著差异，构建了一个多变量逻辑回归模型来预测 RHC 时肺动脉高压的存在。该评分使用右心房和心室舒张面积、三尖瓣反流 Vmax、三尖瓣反流严重程度和左心室射血分数计算。因此，评分的曲线下面积为 0.786（P=0.0001），高于三尖瓣反流 Vmax（P=0.06）。评分值大于 57 与 93%的敏感性、67%的特异性、91%的阳性预测值、73%的阴性预测值和 27 的比值比（OR）（P<0.001）相关，即使在多变量分析校正后，该结果仍然显著。在具有相似结果的验证队列中评估了预测模型的准确性（P=无统计学意义）。
一个简单的非侵入性超声心动图评分可用于预测 RHC 时肺动脉高压的诊断，可用于选择应行或可避免 RHC 的患者。
