Oğuz Mustafa, Uzun Mehmet, Yılmaz İrem, Erdem Almina, Demirci Murat, Duran Nilüfer Ekşi
Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Tibbiye Street, Istanbul 34668, Turkey.
Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Tibbiye Street, Istanbul 34668, Turkey.
Heart Lung. 2025 Mar-Apr;70:50-56. doi: 10.1016/j.hrtlng.2024.11.007. Epub 2024 Nov 20.
Pulmonary hypertension (PH) involves increased arterial stiffness and reduced vascular tone, affecting pulmonary arterial wave reflections. The Reflection Index (RI) may provide insights into these changes.
This study examines the utility of RI in PH patients by correlating it with key right heart catheterization (RHC) parameters.
Patients who underwent RHC with a preliminary diagnosis of PH, including those with normal RHC findings and those diagnosed with Group 1 and Group 4 PH, were included in the study. RI was defined as the ratio of systolic to diastolic pressure differences from pulmonary arterial waveforms and compared with hemodynamic, clinical, and echocardiographic parameters.
The study included 115 patients (mean age 53.92 ± 16.43 years; 43.5% male). RI showed significant correlations with key RHC parameters, such as sPAP (r=0.359, p<0.001), dPAP (r=0.322, p<0.001), mPAP (r=0.339, p<0.001), PVR (r=0.431, p<0.001), and pSO2 (r=-0.243, p=0.011). Among echocardiographic measures, RI correlated with TRV (r=0.377, p<0.001) and echo sPAP (r=0.359, p<0.001). In multivariable analysis, RI (OR:1.032, p=0.003) and NT-proBNP (OR:1.004, p=0.049) remained significant predictors of PH. ROC analysis demonstrated the moderate predictive power for RI (AUC=0.806, p<0.001), with 76.4% sensitivity and 78.5% specificity at a cut-off of 232.05.
RI is a valuable parameter for assessing pulmonary arterial stiffness and vascular tone in patients with PAH and CTEPH. Significant correlations were observed with key hemodynamic parameters, including PVR and mPAP. Additionally, RI demonstrated moderate predictive power for PH. These findings highlight the potential of RI as an independent marker of vascular health, providing direct insights into the pulmonary arterial bed.
肺动脉高压（PH）涉及动脉僵硬度增加和血管张力降低，影响肺动脉波反射。反射指数（RI）可能有助于了解这些变化。
本研究通过将RI与关键的右心导管检查（RHC）参数相关联，探讨其在PH患者中的应用价值。
纳入初步诊断为PH且接受RHC的患者，包括RHC结果正常的患者以及诊断为1组和4组PH的患者。RI定义为肺动脉波形收缩压与舒张压差值之比，并与血流动力学、临床和超声心动图参数进行比较。
该研究纳入了115例患者（平均年龄53.92±16.43岁；43.5%为男性）。RI与关键的RHC参数显著相关，如收缩期肺动脉压（sPAP，r=0.359，p<0.001）、舒张期肺动脉压（dPAP，r=0.322，p<0.001）、平均肺动脉压（mPAP，r=0.339，p<0.001）、肺血管阻力（PVR，r=0.431，p<0.001）和动脉血氧分压（pSO2，r=-0.243，p=0.011）。在超声心动图测量中，RI与三尖瓣反流速度（TRV，r=0.377，p<0.001）和超声心动图sPAP（r=0.359，p<其在PH诊断中的预测价值。
RI是评估PAH和CTEPH患者肺动脉僵硬度和血管张力的重要参数。与包括PVR和mPAP在内的关键血流动力学参数存在显著相关性。此外，RI对PH具有中等预测能力。这些发现凸显了RI作为血管健康独立标志物的潜力，为肺动脉床提供了直接的见解。 001）相关。在多变量分析中，RI（比值比：1.032，p=0.003）和N末端脑钠肽前体（NT-proBNP，比值比：1.004，p=0.049）仍然是PH的显著预测因子。ROC分析显示RI具有中等预测能力（曲线下面积=0.806，p<0.001），在临界值为232.05时，敏感性为76.4%，特异性为78.5%。
