Oguz Mustafa, Yılmaz İrem, Erdem Almina, Imre Gürkan, Eksi Nilufer D, Uzun Mehmet
Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey.
Van Training and Research Hospital, Van, Turkey.
Postepy Kardiol Interwencyjnej. 2024 Dec;20(4):449-454. doi: 10.5114/aic.2024.144977. Epub 2024 Nov 12.
Pulmonary hypertension (PH) is characterized by increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) due to loss of arterial elasticity and vascular obstruction. The dicrotic notch index (DNI) represents reflected wave characteristics and vascular elasticity, potentially serving as an important marker in PH assessment.
This study evaluates the relationship between DNI and PVR, PAPs, and other hemodynamic and clinical parameters in PH patients.
A retrospective analysis was conducted on 76 patients diagnosed with pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH), or normal PAPs who underwent right heart catheterization (RHC). PAP waveforms were analyzed to determine DNI. Correlations between DNI and hemodynamic, clinical, and echocardiographic parameters were assessed using Pearson's correlation coefficient. Logistic regression and ROC analysis were performed to evaluate the DNI's predictive value.
DNI showed significant positive correlations with systolic PAP (sPAP) ( = 0.972, < 0.001), diastolic PAP (dPAP) ( = 0.876, < 0.001), mean PAP (mPAP) ( = 0.987, < 0.001), right atrial (RA) pressure ( = 0.741, = 0.018), and PVR ( = 0.814, < 0.001). Significant negative correlations were observed with cardiac index (CI) ( = -0.573, = 0.012) and pSO ( = -0.516, = 0.043). Univariable logistic regression identified DNI as a significant predictor of PH (O = 1.100, 95% CI: 1.048-1.155, < 0.001). ROC analysis showed an AUC of 0.922 for DNI, indicating excellent predictive value.
DNI is correlated with key hemodynamic parameters such as PVR and mPAP, underscoring its potential as a crucial marker in the assessment of PAH and CTEPH patients. Additionally, DNI exhibited significant correlations with echocardiographic measurements and clinical indicators, suggesting its utility in evaluating pulmonary arterial stiffness and resistance. Further research is needed to validate these findings in larger cohorts and to establish standardized protocols for DNI measurement in clinical practice.
肺动脉高压（PH）的特征是由于动脉弹性丧失和血管阻塞导致肺动脉压（PAP）和肺血管阻力（PVR）增加。重搏波切迹指数（DNI）代表反射波特征和血管弹性，有可能成为PH评估中的一个重要标志物。
本研究评估PH患者中DNI与PVR、PAPs以及其他血流动力学和临床参数之间的关系。
对76例诊断为肺动脉高压（PAH）、慢性血栓栓塞性肺动脉高压（CTEPH）或PAP正常且接受了右心导管检查（RHC）的患者进行回顾性分析。分析PAP波形以确定DNI。使用Pearson相关系数评估DNI与血流动力学、临床和超声心动图参数之间的相关性。进行逻辑回归和ROC分析以评估DNI的预测价值。
DNI与收缩期PAP（sPAP）（r = 0.972，P < 0.001）、舒张期PAP（dPAP）（r = 0.876，P < 0.001）、平均PAP（mPAP）（r = 0.987，P < 0.001）、右心房（RA）压力（r = 0.741，P = 0.018）和PVR（r = 0.814，P < 0.001）呈显著正相关。与心脏指数（CI）（r = -0.573，P = 0.012）和pSO（r = -0.516，P = 0.043）呈显著负相关。单变量逻辑回归确定DNI是PH的显著预测因子（OR = 1.100，95%CI：1.048 - 1.155，P < 0.001）。ROC分析显示DNI的AUC为0.922，表明其具有出色的预测价值。
DNI与PVR和mPAP等关键血流动力学参数相关，突出了其作为评估PAH和CTEPH患者的关键标志物的潜力。此外，DNI与超声心动图测量值和临床指标显著相关，表明其在评估肺动脉僵硬度和阻力方面的实用性。需要进一步研究以在更大队列中验证这些发现，并在临床实践中建立DNI测量的标准化方案。
