Jiang Rong, Wang Lan, Zhao Qin-Hua, Wu Cheng, Yuan Ping, Wang Shang, Zhang Rui, Gong Su-Gang, Wu Wen-Hui, He Jing, Qiu Hong-Ling, Luo Ci-Jun, Liu Jin-Ming, Jing Zhi-Cheng
Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Department of Health Statistics, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China.
J Clin Med. 2022 Mar 14;11(6):1603. doi: 10.3390/jcm11061603.
Severe pulmonary hypertension in chronic lung diseases (severe CLD-PH) differs significantly from other types of PH in physiology and prognosis. We aimed to assess whether echocardiography helps predict long-term survival in patients with severe CLD-PH. This single-centre, observational cohort study enrolled 100 patients with severe CLD-PH (mean pulmonary arterial pressure ≥35 mm Hg or ≥25 mm Hg with cardiac index <2.0 L/min/m2 or pulmonary vascular resistance ≥6 Wood units) between 2009 and 2014. The population was randomly divided into a derivation and validation cohort in a 2:1 ratio. To construct a nomogram, a multivariable logistic regression model was applied, and scores were assigned based on the hazard ratio of independent echocardiographic predictors. Multivariate Cox hazards analysis identified the strongest predictors of mortality as pulmonary arterial systolic pressure (PASP), tricuspid annular plane systolic excursion, and right ventricular end-diastolic transverse dimension. The three independent predictors were entered into the nomogram. Compared with PASP alone, the nomogram resulted in an integrated discrimination improvement of 15.5% (95% confidence interval, 5.52−25.5%, p = 0.002) with a net improvement in model discrimination (C-statistic from 0.591 to 0.746). Using echocardiographic parameters, we established and validated a novel nomogram to predict all-cause death for patients with severe CLD-PH.
慢性肺部疾病中的重度肺动脉高压（重度慢性肺病相关肺动脉高压）在生理和预后方面与其他类型的肺动脉高压有显著差异。我们旨在评估超声心动图是否有助于预测重度慢性肺病相关肺动脉高压患者的长期生存率。这项单中心观察性队列研究纳入了2009年至2014年间100例重度慢性肺病相关肺动脉高压患者（平均肺动脉压≥35mmHg或≥25mmHg且心脏指数<2.0L/min/m²或肺血管阻力≥6伍德单位）。将该人群以2:1的比例随机分为推导队列和验证队列。为构建列线图，应用多变量逻辑回归模型，并根据独立超声心动图预测指标的风险比分配分数。多变量Cox风险分析确定死亡率的最强预测指标为肺动脉收缩压（PASP）、三尖瓣环平面收缩期位移和右心室舒张末期横径。将这三个独立预测指标纳入列线图。与单独使用PASP相比，列线图使综合辨别力提高了15.5%（95%置信区间，5.52−25.5%，p = 0.002），模型辨别力有净提高（C统计量从0.591提高到0.746）。利用超声心动图参数，我们建立并验证了一种新型列线图，以预测重度慢性肺病相关肺动脉高压患者的全因死亡。
