Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China.
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
J Heart Lung Transplant. 2022 Dec;41(12):1831-1838. doi: 10.1016/j.healun.2022.08.016. Epub 2022 Aug 27.
This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters.
A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis.
Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84-0.90, p < 0.01), 0.86 (95% CI: 0.82-0.91, p < 0.01), and 0.85 (95% CI: 0.79-0.90, p < 0.01), respectively.
This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC.
本研究旨在筛选成人先天性心脏病（CHD）患者的矫正资格。右心导管检查（RHC）获得的肺至体循环血流量比（Qp/Qs）>1.5 和肺至体循环血管阻力比（Rp/Rs）<1/3 是两个必要参数。然而，每次随访都进行 RHC 既不切实际，甚至可能有害。因此，建立一种模型，使用超声心动图参数预测 RHC 确认前 Qp/Qs 和 Rp/Rs 的状态非常重要。
共纳入 1785 例成人 CHD 患者，并随机分为推导组或验证组。推导组 974 例患者的超声心动图参数被认为是手术资格（Qp/Qs>1.5 和 Rp/Rs<1/3）的候选预测因子。进行二元逻辑回归分析以确定独立预测因子并建立评分系统。在验证组中使用接受者操作特征（ROC）分析进一步检查评分系统。
估计肺动脉收缩压、肺动脉瓣流速和左右心房直径被确定为独立预测因子。验证组和其三尖瓣畸形前、后亚组的预测值的 ROC 曲线下面积分别为 0.87（95%置信区间 [CI]：0.84-0.90，p<0.01）、0.86（95% CI：0.82-0.91，p<0.01）和 0.85（95% CI：0.79-0.90，p<0.01）。
该评分系统可在 RHC 前增加对 CHD 患者手术资格进行预筛选的灵活性和便利性。
