Liu Yen-Yu, Wu Shu-Hao, Tsai Cheng-Ting, Sun Fang-Ju, Hou Charles Jia-Yin, Yeh Hung-I, Wu Yih-Jer
Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.
Department of Medicine, and Institute of Biomedical Sciences, MacKay Medical College.
Acta Cardiol Sin. 2023 Mar;39(2):319-330. doi: 10.6515/ACS.202303_39(2).20220826A.
We tested the hypothesis that non-invasive pulse wave analysis (PWA)-derived systemic circulation variables can predict invasive hemodynamics of pulmonary circulation and the indicator of right heart function, N-terminal pro-brain natriuretic peptide (NT-proBNP), in patients with precapillary pulmonary hypertension (PH).
This prospective study enrolled patients with group 1 and 4 PH who had complete PWA, NT-proBNP, and hemodynamics data. Risk assessment-based "hemodynamic score (HS)" and principal component analysis-based PWA variable grouping were determined/performed. Models of hierarchical multiple linear regression (HMLR) and receiver operating characteristic (ROC) curves were used to determine the relationships of PWA variables with HS and NT-proBNP and to predict the latter parameters.
Fifty-three PWAs were included. PWA variables were classified into 4 eigenvalue principal components (representing 90% configuration). Univariate analysis showed that left ventricular ejection time (LVET) was significantly negatively associated with HS and NT-proBNP levels. HMLR analysis showed that LVET was still significantly, negatively, and independently associated with HS (B = -0.006 [-0.010-0.001]) and NT-proBNP (B = -13.47 [-21.20-5.73]). ROC curve analysis showed that LVET > 306.9 msec and > 313.2 msec predicted the low-risk group of HS (AUC: 0.802; p = 0.001; sensitivity: 100%; and specificity: 59%) and low-to-intermediate risk levels of NT-proBNP (AUC: 0.831; p < 0.001; sensitivity: 100%; and specificity: 59%).
The non-invasive PWA parameter, LVET, is an independent predictor of invasive right heart HS and NT-proBNP levels; it may serve as a novel biomarker of right ventricular function in patients with pre-capillary PH.
我们检验了这样一个假设，即对于毛细血管前性肺动脉高压（PH）患者，非侵入性脉搏波分析（PWA）得出的体循环变量可预测肺循环的有创血流动力学以及右心功能指标N末端脑钠肽前体（NT-proBNP）。
这项前瞻性研究纳入了1组和4组PH患者，这些患者有完整的PWA、NT-proBNP和血流动力学数据。确定并执行了基于风险评估的“血流动力学评分（HS）”以及基于主成分分析的PWA变量分组。使用分层多元线性回归（HMLR）模型和受试者工作特征（ROC）曲线来确定PWA变量与HS和NT-proBNP的关系，并预测后两个参数。
共纳入53次PWA。PWA变量被分为4个特征值主成分（代表90%的构成）。单因素分析显示，左心室射血时间（LVET）与HS和NT-proBNP水平显著负相关。HMLR分析显示，LVET仍与HS（B = -0.006 [-0.010-0.001]）和NT-proBNP（B = -13.47 [-21.20-5.73]）显著、负向且独立相关。ROC曲线分析显示，LVET > 306.9毫秒和> 313.2毫秒可预测HS的低风险组（AUC：0.802；p = 0.001；敏感性：100%；特异性：59%）以及NT-proBNP的低至中度风险水平（AUC：0.831；p < 0.001；敏感性：100%；特异性：59%）。
非侵入性PWA参数LVET是有创右心HS和NT-proBNP水平的独立预测指标；它可能作为毛细血管前性PH患者右心室功能的一种新型生物标志物。
