Department of Cardiology, Azienda Sanitaria Universitaria Integrata, Trieste, Italy; Division of Cardiology, "Umberto Parini" Hospital, Aosta, Italy.
Department of Cardiology, Azienda Sanitaria Universitaria Integrata, Trieste, Italy; Division of Cardiology, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden.
J Am Soc Echocardiogr. 2022 Jul;35(7):715-726. doi: 10.1016/j.echo.2022.02.003. Epub 2022 Feb 11.
Pulmonary hypertension (PH) is a frequent and detrimental condition. Right heart catheterization (RHC) is the gold standard to identify PH subtype (precapillary from postcapillary PH) and is key for treatment allocation. In this study, the novel echocardiographic biventricular coupling index (BCI), based on the ratio between right ventricular stroke work index and left ventricular E/E' ratio, was tested for the discrimination of PH subtype using RHC as the comparator.
BCI was derived in 334 consecutive patients who underwent transthoracic echocardiography and RHC for all indications. BCI was then tested in a validation cohort of 1,349 patients.
The accuracy of BCI to identify precapillary PH was high in the derivation cohort (area under the curve, 0.82; 95% CI, 0.78-0.88; P < .001; optimal cut point, 1.9). BCI identified patients with precapillary PH with high accuracy also in the validation cohort (area under the curve, 0.87 [95% CI, 0.85-0.89; P < .001]; subgroup with PH: area under the curve, 0.91 [95% CI, 0.89-0.93; P < .001]; cut point, 1.9; sensitivity, 82%; specificity, 89%; positive predictive value, 77%; negative predictive value, 92%). BCI outperformed both the D'Alto score (Z = 3.56; difference between areas = 0.05; 95% CI, 0.02-0.07; P < .001) and the echocardiographic pulmonary-to-left atrial ratio index (Z = 2.88; difference between areas = 0.02; 95% CI, 0.01-0.04; P = .004).
BCI is a novel, noninvasive index based on routinely available echocardiographic parameters that identifies with high accuracy patients with precapillary PH. BCI may be of value in the screening workup of patients with PH.
肺动脉高压（PH）是一种常见且有害的病症。右心导管检查（RHC）是确定 PH 亚型（毛细血管前 PH 与毛细血管后 PH）的金标准，也是治疗分配的关键。在这项研究中，基于右心室每搏功指数与左心室 E/E'比值之比的新型超声心动图双心室耦合指数（BCI），通过 RHC 作为比较器，用于鉴别 PH 亚型。
对 334 例因各种原因接受经胸超声心动图和 RHC 的连续患者进行了 BCI 检测。然后在 1349 例验证队列中对 BCI 进行了测试。
在推导队列中，BCI 对识别毛细血管前 PH 的准确性很高（曲线下面积为 0.82；95%置信区间，0.78-0.88；P<0.001；最佳切点为 1.9）。BCI 在验证队列中也能准确识别出毛细血管前 PH 患者（曲线下面积为 0.87[95%置信区间，0.85-0.89；P<0.001]；亚组 PH：曲线下面积为 0.91[95%置信区间，0.89-0.93；P<0.001]；切点为 1.9；敏感性为 82%；特异性为 89%；阳性预测值为 77%；阴性预测值为 92%）。BCI 优于 D'Alto 评分（Z=3.56；面积差异=0.05；95%置信区间，0.02-0.07；P<0.001）和超声心动图肺静脉与左心房比值指数（Z=2.88；面积差异=0.02；95%置信区间，0.01-0.04；P=0.004）。
BCI 是一种基于常规超声心动图参数的新型无创指数，可高度准确地识别毛细血管前 PH 患者。BCI 可能对 PH 患者的筛查工作有价值。
