Deboever Nathaniel, Eapen George A, Casal Roberto F, Durand Jean-Bernard, Eisenberg Michael A, Feldman Hope, May Celestino, Ali Zohra, Rice David C, Mehran Reza J
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Tex.
JTCVS Tech. 2023 Dec 15;23:146-153. doi: 10.1016/j.xjtc.2023.10.030. eCollection 2024 Feb.
Pulmonary hypertension (PH) is an important physiologic variable in the assessment of patients undergoing major thoracic operations but all too often neglected because of the need for right heart catheterization (RHC) due to the inaccuracy of transthoracic echocardiography. Patients with lung cancer often require endobronchial ultrasound (EBUS) as part of the staging of the cancer. We sought to investigate whether EBUS can be used to screen these patients for PH.
Patients undergoing a major thoracic operation requiring EBUS for staging were included prospectively in the study. All patients had also a RHC (gold standard). We aimed to compare the pulmonary artery pressure measurements by EBUS with the RHC values.
A total of 20 patients were enrolled in the study. The prevalence of abnormal pulmonary artery pressure was 65% based on RHC. All patients underwent measurement of the pulmonary vascular acceleration time (PVAT) by EBUS with no adverse events. Linear regression analysis comparing PVAT and RHC showed a correlation (r = -0.059, -0.010 to -0.018, = .007). A receiver operator characteristic curve (area under the curve = 0.736) was used to find the optimal PVAT threshold (140 milliseconds) to predict PH; this was used to calculate a positive and negative likelihood ratio following a positive diagnosis of 2.154 and 0.538, respectively.
EBUS interrogation of pulmonary artery hemodynamic is safe and feasible. EBUS may be used as a screening test for PH in high-risk individuals.
肺动脉高压（PH）是评估接受大型胸科手术患者时的一个重要生理变量，但由于经胸超声心动图不准确，往往因需要进行右心导管检查（RHC）而被忽视。肺癌患者通常需要进行支气管内超声（EBUS）作为癌症分期的一部分。我们试图研究EBUS是否可用于筛查这些患者的PH。
前瞻性纳入接受需要EBUS分期的大型胸科手术的患者进行研究。所有患者均进行了RHC（金标准）。我们旨在比较EBUS测量的肺动脉压力与RHC值。
共纳入20例患者进行研究。基于RHC，肺动脉压力异常的患病率为65%。所有患者均通过EBUS测量了肺血管加速时间（PVAT），未发生不良事件。比较PVAT和RHC的线性回归分析显示存在相关性（r = -0.059，-0.010至-0.018，P = 0.007）。使用受试者工作特征曲线（曲线下面积 = 0.736）来确定预测PH的最佳PVAT阈值（140毫秒）；这用于计算阳性诊断后的阳性和阴性似然比，分别为2.154和0.538。
EBUS对肺动脉血流动力学的检查是安全可行的。EBUS可作为高危个体PH的筛查试验。
