Novel Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography and Their Diagnostic Value in Pulmonary Hypertension.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2024-11-01 Epub Date: 2024-07-25 DOI:10.1016/j.chest.2024.06.3805
Shadi P Bagherzadeh, Bettia E Celestin, Everton J Santana, Michael Salerno, Kari C Nadeau, Andrew J Sweatt, Roham T Zamanian, Francois Haddad
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引用次数: 0

Abstract

Background: According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter > 25 mm on transthoracic echocardiography supports the diagnosis of PH. However, the size of the pulmonary artery (PA) may vary according to body size, age, and cardiac phases.

Research question: (1) What are the reference limits for PA size on transthoracic echocardiography, considering differences in body size, sex, and age? (2) What is the diagnostic value of the PA size for classifying PH? (3) How does the selection of different reference groups (healthy volunteers vs patients referred for right heart catheterization [RHC]) influence the diagnostic OR (DOR)?

Study design and methods: The study included a reference cohort of 248 healthy individuals as control patients, 693 patients with PH proven by RHC, and 156 patients without PH proven by RHC. In the PH cohort, 300 had group 1 PH, 207 had group 2 PH, and 186 had group 3 PH. MPA and right PA diameters and areas were measured in the upper sternal short-axis and suprasternal notch views. Reference limits (5th-95th percentile) were based on absolute values and height-indexed measures. Quantile regression analysis was used to derive median and 95th quantile reference equations for the PA measures. DORs and probability diagnostic plots for PH were then determined using healthy control and non-PH cohorts.

Results: The 95th percentile for indexed MPA diameter was 15 mm/m in diastole and 19 mm/m in systole in both sexes. Quantile regression analysis revealed a weak age effect (pseudo-R2 of 0.08-0.10 for MPA diameters). Among measures, the MPA size in diastole had the highest DOR (156.2; 95% CI, 68.3-357.5) for detection of group 1 PH. Similarly, the DORs were also high for groups 2 and 3 PH when compared with the control cohort but significantly lower compared with the non-PH cohort.

Interpretation: This study presents novel reference limits for MPA based on height indexing and quantile regression.

利用超声心动图测量肺动脉大小和脉动性的新参考公式及其对肺动脉高压的诊断价值
背景:根据最新的肺动脉高压(PH)指南,经胸超声心动图(TTE)显示主肺动脉(MPA)直径>25毫米可支持PH的诊断。然而,肺动脉(PA)的大小可能因体型、年龄和心脏阶段而异:1)考虑到体型、性别和年龄的差异,TTE 对肺动脉(PA)大小的参考界限是什么?2)PA 大小对肺动脉高压分类的诊断价值是什么?3)选择不同的参照组(健康志愿者与右心导管检查(RHC)转诊患者)对诊断几率(DOR)有什么影响?研究对象包括作为对照的 248 名健康人、693 名经右心导管检查确诊的 PH 患者和 156 名经右心导管检查确诊的非 PH 患者。在 PH 队列中,有 300 人患有第一组 PH,207 人患有第二组 PH,186 人患有第三组 PH。MPA和右PA(RPA)的直径和面积是在胸骨上短轴和胸骨上切迹切面上测量的。参考限值(第5-95百分位数)基于绝对值和身高指数测量值。量值回归分析用于得出 PA 测量的中位数和第 95 个量值参考方程。然后利用健康对照组和非PH队列确定PH的DOR和概率诊断图:结果:男女MPA直径指数的第95百分位数分别为舒张期15毫米/米和收缩期19毫米/米。量子回归分析显示年龄效应较弱(MPA直径的假R2为0.08至0.10)。在各种测量指标中,舒张期MPA尺寸的DOR最高,为156.2(68.3-357.5),用于检测1组PH。同样,与对照组相比,第2组和第3组PH的DOR也很高,但与非PH组相比则明显较低:该研究基于身高指数化和量子回归提出了新的 MPA 参考限值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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