Kucherenko Mariya M, Kukucka Marian, Sang Pengchao, Hegemann Niklas, Li Qiuhua, Hennig Felix, Yeter Ruhi, Gransar Tara, Mladenow Alexander, Emmerich Anna, Orsenigo Andrea, Grune Jana, Falk Volkmar, Kuebler Wolfgang M, Knosalla Christoph
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Cardiovasc Res. 2025 Aug 14;121(9):1433-1447. doi: 10.1093/cvr/cvaf066.
Pulmonary hypertension (PH) is a common complication of left heart disease (LHD) that leads to right heart failure and death. Pulmonary artery (PA) stiffening has recently emerged as an important diagnostic and prognostic parameter in PH. The present study aimed to develop and validate an ultrasonographic index to identify PA stiffening in PH due to LHD.
First, ultrasonographic stiffness index (US-SI) was derived from pulmonary arterial (PA) radial strain (PA-RS), diameter, and stroke volume in rat model and correlated with ex vivo measured 'true' PA stiffness E. Then, US-SI was validated in a cohort of 24 LHD patients with or without PH prior to heart transplantation and again compared with 'true' PA stiffness measured ex vivo in collected PA specimens. In rats, ultrasonographic PA-RS and US-SI correlated closely with E, and both were able to detect 'true' PA stiffening with ≥80% sensitivity and specificity. In LHD patients, even though ultrasonographic right PA radial strain or US-SI correlated similarly with E, observer assessment and testing for diagnostic validity identified US-SI as more robust and accurate method that detects 'true' PA stiffening with 83.3% sensitivity and 95.8% specificity.
Both PA strain and US-SI allow for ultrasonographic detection of PA stiffening in patients or animal models with LHD; however, US-SI identifies patients with stiffened PA with higher diagnostic validity and accuracy.
肺动脉高压（PH）是左心疾病（LHD）的常见并发症，可导致右心衰竭和死亡。肺动脉（PA）僵硬度最近已成为PH的一项重要诊断和预后参数。本研究旨在开发并验证一种超声心动图指数，以识别LHD所致PH中的PA僵硬度。
首先，在大鼠模型中，根据肺动脉（PA）径向应变（PA-RS）、直径和每搏输出量得出超声心动图僵硬度指数（US-SI），并将其与离体测量的“真实”PA僵硬度E相关联。然后，在24例心脏移植术前有或无PH的LHD患者队列中对US-SI进行验证，并再次与收集的PA标本中离体测量的“真实”PA僵硬度进行比较。在大鼠中，超声心动图PA-RS和US-SI与E密切相关，二者均能以≥80%的敏感性和特异性检测到“真实”的PA僵硬度。在LHD患者中，尽管超声心动图右PA径向应变或US-SI与E的相关性相似，但观察者评估和诊断有效性测试确定US-SI是一种更可靠、准确的方法，检测“真实”PA僵硬度的敏感性为83.3%，特异性为95.8%。
PA应变和US-SI均可通过超声心动图检测LHD患者或动物模型中的PA僵硬度；然而，US-SI对PA僵硬度患者的诊断有效性和准确性更高。
