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急诊重症监护病房收治的急性心力衰竭患者肺超声评分与肺动脉收缩压的相关性分析

Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit.

作者信息

Xu Ping, Nasr Basma, Li Liang, Huang Wenbin, Liu Wei, Wang Xuelian

机构信息

Emergency Department, Zigong Fourth People's Hospital, Zigong, China.

Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China.

出版信息

J Intensive Med. 2023 Oct 20;4(1):125-132. doi: 10.1016/j.jointm.2023.08.005. eCollection 2024 Jan.

Abstract

BACKGROUND

No convenient, inexpensive, and non-invasive screening tools exist to identify pulmonary hypertension (PH) - left heart disease (LHD) patients during the early stages of the disease course. This study investigated whether different methods of lung ultrasound (LUS) could be used for the initial investigation of PH-LHD.

METHODS

This was a single-center prospective observational study which was performed in the Zigong Fourth People's Hospital. We consecutively enrolled patients with heart failure (HF) admitted to the emergency intensive care unit from January 2018 to May 2020. Transthoracic echocardiography and LUS were performed within 24 h before discharge. We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure (PASP). Bland-Altman plots were generated to inspect possible bias, and receiver operating characteristic (ROC) curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.

RESULTS

Seventy-one patients were enrolled in this study, with an overall median age of 79 (interquartile range: 71.5-84.0) years. Among the 71 patients, 36 (50.7%) cases were male, and 26 (36.6%) had an intermediate and high echocardiographic probability of PH. All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH ( <0.05). The correlation coefficient () between different LUS scoring methods and PASP was moderate for the 6-zone (=0.455,  <0.001), 8-zone (=0.385, =0.001), 12-zone (=0.587,  <0.001), and 28-zone (=0.535,  <0.001) methods. In Bland-Altman plots, each of the four LUS scoring methods had a good agreement with PASP ( <0.001). The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH ( <0.05).

CONCLUSIONS

LUS is a readily available, inexpensive, and risk-free method that moderately correlates with PASP. LUS is a potential screening tool used for the initial investigation of PH-LHD, especially in emergencies or critical care settings.

摘要

背景

在疾病进程的早期阶段,尚无便捷、廉价且无创的筛查工具来识别肺动脉高压(PH)合并左心疾病(LHD)的患者。本研究调查了不同的肺部超声(LUS)方法是否可用于PH-LHD的初步检查。

方法

这是一项在自贡市第四人民医院进行的单中心前瞻性观察性研究。我们连续纳入了2018年1月至2020年5月入住急诊重症监护病房的心力衰竭(HF)患者。在出院前24小时内进行经胸超声心动图和LUS检查。我们使用Spearman系数对超声评分与肺动脉收缩压(PASP)之间进行相关性分析。生成Bland-Altman图以检查可能的偏差,并计算受试者工作特征(ROC)曲线以评估超声评分与PH-LHD的中等及高超声心动图概率之间的关系。

结果

本研究共纳入71例患者,总体中位年龄为79岁(四分位间距:71.5 - 84.0岁)。在这71例患者中,36例(50.7%)为男性,26例(36.6%)具有中等及高超声心动图概率的PH。PH中等及高概率患者的所有四项LUS评分均显著高于PH低概率患者(<0.05)。对于6区(=0.455,<0.001)、8区(=0.385,=0.001)、12区(=0.587,<0.001)和28区(=0.535,<0.001)方法,不同LUS评分方法与PASP之间的相关系数为中等。在Bland-Altman图中,四种LUS评分方法中的每一种与PASP均具有良好的一致性(<0.001)。8区和12区方法在区分具有中等及高超声心动图概率的PH患者方面显示出中等准确的判别价值(<0.05)。

结论

LUS是一种易于获得、廉价且无风险的方法,与PASP具有中等相关性。LUS是一种潜在的筛查工具,可用于PH-LHD的初步检查,尤其是在急诊或重症监护环境中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9886/10800768/6ccc996984cc/gr1.jpg

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