Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure.

IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
JRSM Cardiovascular Disease Pub Date : 2020-11-12 eCollection Date: 2020-01-01 DOI:10.1177/2048004020973834
Simon Wernhart, Jürgen Hedderich
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引用次数: 2

Abstract

Objective: Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH.

Methods and design: We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC.

Main outcome measures: In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PAmean, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis.

Results: We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VCmax), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08-4.65) and 1.86 (1.11-3.21) for a 1 l decrease in VCmax. On their own, VCmax proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH.

Conclusions: We provide a combinatorial model to predict PH from sPAP and VCmax in older adults, which may help to avoid invasive procedures.

Abstract Image

Abstract Image

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基于肺活量和肺动脉收缩压的老年人肺动脉高压预测。
目的:右心导管(RHC)与老年人较高的手术风险相关,但肺动脉高压(PH)的无创评估是一个挑战。我们的目的是建立一个无创预测模型来估计ph。方法和设计:我们回顾性分析了134名老年人(70.0岁±12.3岁;44.9%男性),在2015年1月至2020年1月期间报告有不明确的呼吸困难,并接受RHC作为诊断检查的一部分。RHC 24小时内进行肺功能检查、血气分析、6 min步行距离及超声心动图检查。主要结果测量:采用逐步统计方法,采用内/排除算法(使用AIC标准),我们分析了非侵入性参数,以检验其预测PH(定义为平均肺动脉压,PAmean, >25mmHg)的价值。最终模型的识别能力由ROC(受试者工作特征)分析得出的AUC(曲线下面积)来衡量。结果:肺动脉收缩压(sPAP)和肺活量(VCmax)联合logistic模型的敏感性为87.2%,特异性为62.5%,鉴别指数为86.7%。sPAP升高10 mmHg的比值比为2.99 (2.08-4.65),VCmax降低1 l的比值比为1.86(1.11-3.21)。VCmax是特异性的(83.3%),而sPAP是PH的敏感预测因子(79.1%)。结论:我们提供了一个组合模型来预测老年人sPAP和VCmax的PH,这可能有助于避免侵入性手术。
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
JRSM Cardiovascular Disease
JRSM Cardiovascular Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
6.20%
发文量
12
审稿时长
12 weeks
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