Chubuchny Vladislav, Pugliese Nicola Riccardo, Taddei Claudia, Poggianti Elisa, Spini Valentina, Barison Andrea, Formichi Bruno, Airò Edoardo, Bauleo Carolina, Prediletto Renato, Pastormerlo Luigi Emilio, Coceani Michele, Ciardetti Marco, Petersen Christina, Pasanisi Emilio, Lombardi Carlo, Emdin Michele, Giannoni Alberto
Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.
Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
ESC Heart Fail. 2021 Apr;8(2):1216-1229. doi: 10.1002/ehf2.13183. Epub 2021 Feb 10.
This study aimed to evaluate a novel echocardiographic algorithm for quantitative estimation of pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR) in patients with heart failure and pulmonary hypertension (PH) scheduled to right heart catheterization (RHC).
In this monocentric study, 795 consecutive patients (427 men; age 68.4 ± 12.1 years) undergoing echocardiography and RHC were evaluated. Multiple regression analysis was performed to identify echocardiographic predictors of PAWP and PVR measured by RHC in the derivation group (the first 200 patients). The diagnostic accuracy of the model was then tested in the validation group (the remaining 595 patients). PH was confirmed by RHC in 507 (63.8%) patients, with 192 (24.2%) cases of precapillary PH, 248 (31.2%) of postcapillary PH, and 67 (8.4%) of combined PH. At regression analysis, tricuspid regurgitation maximal velocity, mitral E/e' ratio, left ventricular ejection fraction, right ventricular fractional area change, inferior vena cava diameter, and left atrial volume index were included in the model (R = 0.8, P < 0.001). The model showed a high diagnostic accuracy in estimating elevated PAWP (area under the receiver operating characteristic curve = 0.97, 92% sensitivity, and 93% specificity, P < 0.001) and PVR (area under the receiver operating characteristic curve = 0.96, 89% sensitivity, and 92% specificity, P < 0.001), outperforming 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations (P < 0.001) and Abbas' equation (P < 0.001). Bland-Altman analysis showed satisfactory limits of agreement between echocardiography and RHC for PAWP (bias 0.7, 95% confidence interval -7.3 to 8.7) and PVR (bias -0.1, 95% confidence interval -2.2 to 1.9 Wood units), without indeterminate cases.
A novel quantitative echocardiographic approach for the estimation of PAWP and PVR has high diagnostic accuracy in patients with heart failure and PH.
本研究旨在评估一种新型超声心动图算法，用于对计划进行右心导管检查（RHC）的心力衰竭和肺动脉高压（PH）患者的肺动脉楔压（PAWP）和肺血管阻力（PVR）进行定量估计。
在这项单中心研究中，对795例连续接受超声心动图检查和RHC的患者（427例男性；年龄68.4±12.1岁）进行了评估。在推导组（前200例患者）中进行多元回归分析，以确定RHC测量的PAWP和PVR的超声心动图预测指标。然后在验证组（其余595例患者）中测试该模型的诊断准确性。RHC确诊507例（63.8%）患者患有PH，其中192例（24.2%）为毛细血管前性PH，248例（31.2%）为毛细血管后性PH，67例（8.4%）为混合性PH。回归分析时，模型纳入了三尖瓣反流最大速度、二尖瓣E/e'比值、左心室射血分数、右心室面积变化分数、下腔静脉直径和左心房容积指数（R = 0.8，P < 0.001）。该模型在估计升高的PAWP（受试者工作特征曲线下面积 = 0.97，灵敏度92%，特异度93%，P < 0.001）和PVR（受试者工作特征曲线下面积 = 0.96，灵敏度89%，特异度92%，P < 0.001）方面显示出较高的诊断准确性，优于2016年美国超声心动图学会/欧洲心血管影像协会的推荐方法（P < 0.001）和阿巴斯方程（P < 0.001）。布兰德-奥特曼分析显示，超声心动图与RHC在PAWP（偏差0.7，95%置信区间-7.3至8.7）和PVR（偏差-0.1，95%置信区间-2.2至1.9伍德单位）方面的一致性界限令人满意，无不确定病例。
一种用于估计PAWP和PVR的新型定量超声心动图方法在心力衰竭和PH患者中具有较高的诊断准确性。
