Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Functional Assessment
2.3. Biochemical Markers
2.4. Echocardiography
2.5. Right Heart Catheterization
2.6. Division Into Risk Categories
2.7. Statistical Analysis
2.8. Test Construction
2.9. Test Validation
3. Results
3.1. Study Population
3.2. Univariable Analysis
3.2.1. Correlation between prognostic variables assessed at RHC
3.2.2. Correlation between Non-Invasive Variables and Hemodynamic Indices
3.2.3. Time Interval between Noninvasive and Invasive Assessment
3.2.4. ROC Curve Analysis
3.3. Multivariate Logistic Regression Models
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AcT | acceleration time |
CI | cardiac index |
COPD | chronic obstructive pulmonary disease |
CTEPH | chronic thromboembolic pulmonary hypertension |
HR | heart rate |
IQR | interquartile range |
IVCex | inferior vena cava expiratory diameter |
IVCin | inferior vena cava inspiratory diameter |
IVCcoll | inferior vena cava collapsibility index |
IRTB | multivariable model based on 4 predictors: IVCin, RAA, TAPSE and NTproBNP |
LA | left atrium |
MPA | main pulmonary artery diameter |
mPAP | mean pulmonary arterial pressure |
mRAP | mean right atrial pressure |
n | number of cases |
NTproBNP | N-terminated type B natriuretic pro-peptide |
PAH | pulmonary arterial hypertension |
PASP | systolic pulmonary arterial pressure |
PH | pulmonary hypertension |
PAWP | pulmonary artery wedge pressure |
PVR | pulmonary vascular resistance |
RAA | right atrium area |
RVOT | right ventricle outflow tract |
RVIT | right ventricle inflow tract |
RV/LV | right ventricle to left ventricle diameters ratio |
RV wall | right ventricle wall thickness |
6MWD | 6-minutes’ walk distance |
TAPSE | tricuspid annular plane systolic excursion |
TnT | troponin T |
TRPG | tricuspid regurgitation peak gradient |
SaO2 | arterial blood oxygenation |
SvO2 | mixed venous oxygen saturation |
WHO-FC | World Health Organization functional class |
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Hemodynamic Index (RHC) | Low-Risk Category (All Criteria Required) | High-Risk Category (Required at Least One of Following) |
---|---|---|
mRAP [mmHg] | <8 | >14 |
CI [L/min·m2] | ≥2.5 | <2.0 |
SvO2 [%] | >65 | <60 |
Training Group n =330 | Validation Group n = 136 | p | |
---|---|---|---|
Female | 202 (61%) | 79 (58%) | 0.531 |
Etiological groups of PH | |||
1: PAH | 127 (38.5%) | 57 (41.9%) | 0.857 |
2: PH due to left heart disease | 38 (11.5%) | 11 (8.1%) | |
3: PH due to lung disease or hypoxia | 21 (6.4%) | 9 (6.6%) | |
4: CTEPH | 93 (28.2%) | 40 (29.4%) | |
5: PH with unclear or multifactorial mechanism | 6 (1.8%) | 2 (1.5%) | |
non-PH (mPAP < 25 mm Hg) | 39 (11.8%) | 13 (9.6%) | |
Pericardial constriction | 6 (1.8%) | 4 (2.9%) | |
Comorbidities | |||
Atrial fibrillation | 64 (19%) | 20 (15%) | 0.231 |
Chronic obstructive pulmonary disease | 40 (12%) | 20 (15%) | 0.449 |
Pulmonary fibrosis | 15 (5%) | 14 (10%) | 0.020 |
Systemic-pulmonary shunt | 8 (2%) | 6 (4%) | 0.683 |
Functional class according WHO classification | |||
WHO FC 1 | 13 (4%) | 7 (5%) | 0.579 |
WHO FC 2 | 77 (23%) | 39 (29%) | |
WHO FC 3 | 187 (57%) | 69 (51%) | |
WHO FC 4 | 51 (16%) | 21 (15%) | |
unspecified | 2 (< 1%) | 0 | |
Risk category according RHC findings | |||
Low-risk category | 54 (16%) | 37 (27%) | 0.027 |
Intermediate-risk category | 139 (42%) | 46 (34%) | |
High-risk category | 137 (42%) | 53 (39%) |
Training Group | Validation Group | p | |||||
---|---|---|---|---|---|---|---|
n | median | IQR | n | median | IQR | ||
Age [yrs] | 330 | 61 | 46–71 | 136 | 62 | 45–72 | 0.737 |
Weight [kg] | 330 | 72 | 63–88 | 136 | 75 | 66–87 | 0.540 |
Height [m] | 330 | 1.66 | 1.59–1.72 | 136 | 1.67 | 1.60–1.72 | 0.861 |
BSA [m2] | 330 | 1.83 | 1.67–1.98 | 136 | 1.80 | 1.70–1.99 | 0.675 |
BMI [kg/m2] | 330 | 26.6 | 23.2–31.2 | 136 | 26.6 | 23.5–31.2 | 0.591 |
Resting hemodynamics | |||||||
HR [s−1] | 330 | 73 | 65–84 | 136 | 73 | 65–83 | 0.889 |
mRAP [mmHg] | 330 | 8 | 5–12 | 136 | 8 | 5–12 | 0.615 |
PASP [mmHg] | 330 | 68 | 46–85 | 136 | 66 | 46–82 | 0.408 |
mPAP [mmHg] | 330 | 42 | 31–54 | 136 | 41 | 30–53 | 0.556 |
PAWP [mmHg] | 326 | 11 | 8–13 | 136 | 10 | 8–13 | 0.220 |
CI [l/min⋅m2] | 330 | 2.41 | 2.02–2.89 | 136 | 2.49 | 2.03–2.98 | 0.391 |
SaO2 [%] | 328 | 96 | 93–98 | 136 | 95 | 93–98 | 0.966 |
SvO2 [%] | 324 | 63 | 58–68 | 136 | 65 | 60–70 | 0.006 |
PVR [Wood units] | 330 | 6.7 | 3.2–10.8 | 136 | 6.8 | 3.4–10.6 | 0.916 |
Biomarkers | |||||||
NTproBNP [ng/l] | 309 | 1043 | 260–2519 | 136 | 670 | 242–2023 | 0.251 |
TnT [ng/l] | 219 | 12 | 6–19 | 129 | 12 | 6–22 | 0.917 |
6MWT | |||||||
distance [m] | 216 | 360 | 254–466 | 101 | 387 | 280–468 | 0.509 |
Echocardiography | |||||||
IVCex [mm] | 326 | 20 | 17–24 | 136 | 19 | 16–23 | 0.163 |
IVCin [mm] | 325 | 11 | 7–17 | 136 | 8 | 5–16 | 0.001 |
IVCcoll [%] | 325 | 41 | 23–57 | 136 | 54 | 35–70 | <0.001 |
RAA [cm2] | 329 | 24 | 19–31 | 136 | 23 | 19–30 | 0.967 |
RVOT [mm] | 330 | 37 | 32–41 | 135 | 36 | 32–41 | 0.752 |
RVIT [mm] | 298 | 44 | 38–53 | 134 | 45 | 40–53 | 0.236 |
RV/LV | 296 | 1.08 | 0.84–1.52 | 134 | 1.12 | 0.89–1.49 | 0.334 |
RV wall [mm] | 254 | 7 | 5–8 | 129 | 6 | 5–8 | 0.539 |
MPA [mm] | 316 | 30 | 26–34 | 132 | 29 | 26–34 | 0.416 |
LA [mm] | 329 | 39 | 34–43 | 134 | 38 | 34–42 | 0.521 |
TAPSE [mm] | 330 | 18 | 15–22 | 136 | 17 | 14–22 | 0.217 |
AcT [s] | 326 | 74 | 63–88 | 132 | 75 | 67–92 | 0.597 |
TRPG [mmHg] | 308 | 58 | 40–75 | 131 | 55 | 41–71 | 0.669 |
Test | Cut-Off Point | Sensitivity | Specificity | PPV | NPV | Accuracy |
---|---|---|---|---|---|---|
low-risk category prediction | ||||||
RAA | <18 cm2 | 51% | 91% | 68% | 83% | 80% |
NTproBNP | <300 pg/mL | 57% | 84% | 57% | 84% | 76% |
IRTB-low | >0.348 | 57% | 93% | 75% | 85% | 83% |
high-risk category prediction | ||||||
RAA | >26 cm2 | 60% | 75% | 60% | 75% | 69% |
NTproBNP | >1400 pg/mL | 64% | 78% | 65% | 77% | 73% |
IRTB-high | >0.514 | 60% | 87% | 74% | 77% | 76% |
Model | β0 | βi | Parameter |
---|---|---|---|
high-risk | −5.374 | 0.053 | IVCin |
0.030 | RAA | ||
−0.055 | TAPSE | ||
0.645 | ln(NTproBNP) | ||
low-risk | 2.321 | −0.062 | IVCin |
−0.130 | RAA | ||
0.074 | TAPSE | ||
−0.332 | ln(NTproBNP) |
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Mańczak, R.; Kurzyna, M.; Piłka, M.; Darocha, S.; Florczyk, M.; Wieteska-Miłek, M.; Mańczak, M.; Torbicki, A. Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters. Diagnostics 2020, 10, 644. https://doi.org/10.3390/diagnostics10090644
Mańczak R, Kurzyna M, Piłka M, Darocha S, Florczyk M, Wieteska-Miłek M, Mańczak M, Torbicki A. Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters. Diagnostics. 2020; 10(9):644. https://doi.org/10.3390/diagnostics10090644
Chicago/Turabian StyleMańczak, Rafał, Marcin Kurzyna, Michał Piłka, Szymon Darocha, Michał Florczyk, Maria Wieteska-Miłek, Małgorzata Mańczak, and Adam Torbicki. 2020. "Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters" Diagnostics 10, no. 9: 644. https://doi.org/10.3390/diagnostics10090644