Mesin Luca, Policastro Piero, Albani Stefano, Petersen Christina, Sciarrone Paolo, Taddei Claudia, Giannoni Alberto
Mathematical Biology and Physiology, Department Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy.
SC Cardiologia Ospedale Regionale U. Parini, 11100 Aosta, Italy.
J Clin Med. 2022 Jun 7;11(12):3257. doi: 10.3390/jcm11123257.
The non-invasive estimation of right atrial pressure (RAP) would be a key advancement in several clinical scenarios, in which the knowledge of central venous filling pressure is vital for patients’ management. The echocardiographic estimation of RAP proposed by Guidelines, based on inferior vena cava (IVC) size and respirophasic collapsibility, is exposed to operator and patient dependent variability. We propose novel methods, based on semi-automated edge-tracking of IVC size and cardiac collapsibility (cardiac caval index—CCI), tested in a monocentric retrospective cohort of patients undergoing echocardiography and right heart catheterization (RHC) within 24 h in condition of clinical and therapeutic stability (170 patients, age 64 ± 14, male 45%, with pulmonary arterial hypertension, heart failure, valvular heart disease, dyspnea, or other pathologies). IVC size and CCI were integrated with other standard echocardiographic features, selected by backward feature selection and included in a linear model (LM) and a support vector machine (SVM), which were cross-validated. Three RAP classes (low < 5 mmHg, intermediate 5−10 mmHg and high > 10 mmHg) were generated and RHC values used as comparator. LM and SVM showed a higher accuracy than Guidelines (63%, 71%, and 61% for LM, SVM, and Guidelines, respectively), promoting the integration of IVC and echocardiographic features for an improved non-invasive estimation of RAP.
右心房压力（RAP）的无创估计在多种临床场景中将是一项关键进展，在这些场景中，中心静脉充盈压的信息对于患者管理至关重要。指南提出的基于下腔静脉（IVC）大小和呼吸相可塌陷性的RAP超声心动图估计方法，存在操作者和患者依赖性变异。我们提出了基于IVC大小半自动边缘跟踪和心脏可塌陷性（心脏腔静脉指数——CCI）的新方法，并在一个单中心回顾性队列中进行了测试，该队列中的患者在临床和治疗稳定状态下于24小时内接受了超声心动图检查和右心导管检查（RHC）（170例患者，年龄64±14岁，男性占45%，患有肺动脉高压、心力衰竭、瓣膜性心脏病、呼吸困难或其他疾病）。IVC大小和CCI与其他标准超声心动图特征相结合，通过向后特征选择进行选择，并纳入线性模型（LM）和支持向量机（SVM），并进行交叉验证。生成了三个RAP类别（低<5 mmHg、中5 - 10 mmHg和高>10 mmHg），并将RHC值用作对照。LM和SVM显示出比指南更高的准确性（LM、SVM和指南的准确率分别为63%、71%和61%），促进了IVC和超声心动图特征的整合，以改进RAP的无创估计。
