Wernhart Simon, Hedderich Jürgen
Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany.
West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
JRSM Cardiovasc Dis. 2020 Nov 12;9:2048004020973834. doi: 10.1177/2048004020973834. eCollection 2020 Jan-Dec.
Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH.
We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC.
In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PA, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis.
We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VC), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08-4.65) and 1.86 (1.11-3.21) for a 1 l decrease in VC. On their own, VC proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH.
We provide a combinatorial model to predict PH from sPAP and VC in older adults, which may help to avoid invasive procedures.
右心导管检查（RHC）在老年人中具有较高的操作风险，但肺动脉高压（PH）的无创评估具有挑战性。我们旨在构建一种无创预测模型来评估PH。
我们回顾性分析了134例老年人（70.0岁±12.3；44.9%为男性），这些患者在2015年1月至2020年1月期间因呼吸困难情况不明前来我院就诊，并接受了RHC作为诊断检查的一部分。在RHC后24小时内进行了肺功能测试、血气样本分析、6分钟步行距离测试和超声心动图检查。
采用逐步统计方法，通过纳入/排除算法（使用AIC标准）分析无创参数，以检验其在预测PH（定义为平均肺动脉压，PA，>25mmHg）方面的价值。最终模型的辨别能力通过ROC（受试者工作特征）分析中的AUC（曲线下面积）来衡量。
在一个包含收缩期肺动脉压（sPAP）和用力肺活量（VC）的组合逻辑模型中，我们得到了87.2%的灵敏度和62.5%的特异度，辨别指数为86.7%。sPAP每升高10mmHg的比值比为2.99（2.08 - 4.65），VC每降低1L的比值比为1.86（1.11 - 3.21）。单独来看，VC具有特异性（83.3%），而sPAP是PH的敏感预测指标（79.1%）。
我们提供了一个从sPAP和VC预测老年人PH的组合模型，这可能有助于避免侵入性操作。
