Echocardiography Nomogram for Predicting Survival among Chronic Lung Disease Patients with Severe Pulmonary Hypertension
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection and Study Design
2.2. Echocardiographic Measurement
2.3. Haemodynamic Measurements
Follow-up
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Risk Score Construction in the Derivation Cohort
3.3. Nomogram for Predicting All-Cause Mortality
3.4. External Validation in the Validation Cohort
3.5. Subgroup Analysis
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CLD | chronic lung diseases |
ENDSEI | end-systolic stage left ventricular eccentricity index |
mPAP | mean pulmonary artery pressure |
PAd | pulmonary artery dilation |
PAH | pulmonary arterial hypertension |
RALD | right atrial longitudinal dimension |
RATD | right atrial transverse dimension |
RVEDLD | right ventricular end-diastolic longitudinal dimension |
RVEDTD | right ventricular end-diastolic transverse dimension |
TAPSE | tricuspid annular plane systolic excursion |
References
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Variable | Derivation Cohort | Validation Cohort | p Value |
---|---|---|---|
(n = 67) | (n = 33) | ||
Age (years) | 58.0 ± 12.9 | 61.8 ± 11.3 | 0.142 |
Male, n (%) | 38 (56.7) | 24 (84.8) | 0.187 |
BSA (m2) | 1.60 ± 0.2 | 1.59 ± 0.1 | 0.797 |
Aetiology, n (%) | |||
COPD | 52 (77.6) | 24 (72.4) | 0.490 |
Interstitial lung disease | 8 (11.9) | 2 (6.1) | 0.339 |
Asthma | 3 (4.5) | 0 | 0.549 |
Pneumoconiosis | 2 (3.0) | 1 (3.0) | 1.000 |
CPFE | 3 (4.5) | 1 (3.0) | 0.928 |
Post tubercular sequelae | 1 (1.5) | 0 | 1.000 |
Sleep-disordered breathing | 2 (3.0) | 1 (3.0) | 1.000 |
Chest wall abnormalities | 1 (1.5) | 0 | 1.000 |
Comorbidities, n (%) | |||
Systemic hypertension | 10 (14.9) | 4 (12.1) | 1.000 |
Diabetes mellitus | 2 (3.0) | 1 (3.0) | 1.000 |
Coronary heart disease | 1 (1.5) | 1 (3.0) | 1.000 |
Malignant tumour | 1 (1.5) | 0 | 1.000 |
Arrhythmia | 3 (4.5) | 2 (6.1) | 1.000 |
Hyperlipidaemia | 0 | 1 (3.0) | 0.330 |
Previous cerebral infarction | 1 (1.5) | 0 | 1.000 |
Pulmonary function test | |||
FEV1% predicted | 32.3 (24.0, 44.0) | 35.5 (35.6, 49.4) | 0.127 |
FVC% predicted | 54.9 (40.9, 63.4) | 60.1 (57.9, 72.7) | 0.081 |
FEV1/FVC | 47.4 (42.9, 56.1) | 47.7 (47.1, 56.1) | 0.823 |
RV% predicted | 197.9 (137.9, 251.4) | 116.4 (155.7, 206.3) | 0.220 |
TLC% predicted | 115.5 (92.0, 131.7) | 108.8 (98.7, 117.6) | 0.440 |
DLco% predicted | 40.9 (27.9, 56.2) | 40.9 (36.4, 61.6) | 1.000 |
Haemodynamics | |||
mRAP, mmHg | 7.0 (4.8, 9.3) | 7.0 (5.6, 8.5) | 0.541 |
mPAP, mm Hg | 46.0 (42.0, 55.0) | 44.0 (41.8, 49.2) | 0.108 |
PAWP, mm Hg | 9.0 (6.0, 13.0) | 8.0 (7.6, 10.2) | 0.348 |
CO, L/min | 4.6 (4.0, 5.7) | 4.5 (4.1, 5.3) | 0.139 |
CI, L/min/m2 | 3.1 (2.6, 3.7) | 2.7 (2.5, 3.1) | 0.035 |
PVR, Wood units | 8.0 (6.3, 10.2) | 8.0 (7.1, 9.1) | 0.895 |
Echocardiography | |||
LVEF, % | 70.9 ± 9.0 | 68.9 ± 9.9 | 0.315 |
LA, cm | 3.1 ± 0.6 | 3.5 ± 0.7 | 0.799 |
LVDED, cm | 4.0 (3.5, 4.4) | 3.9 (3.7, 4.2) | 0.629 |
LVSED, cm | 2.3 ± 0.6 | 2.4 ± 0.6 | 0.949 |
RATD, cm | 4.8 (4.3, 5.5) | 4.9 (4.8, 5.6) | 0.200 |
RALD, cm | 5.2 (4.3, 5.9) | 5.0 (5.4, 5.9) | 0.175 |
RVEDTD, cm | 4.3 (3.8, 5.0) | 4.3 (4.0, 4.9) | 0.670 |
RVEDLD, cm | 6.6 ± 0.9 | 6.8 ± 0.9 | 0.271 |
PASP, mmHg | 76.2 ± 22.6 | 74.1 ± 24.4 | 0.533 |
TAPSE, cm | 1.7 (1.5, 1.9) | 1.8 (1.6, 1.8) | 0.921 |
PAd, cm | 2.9 (2.6, 3.2) | 3.1 (2.9, 3.4) | 0.208 |
ENDSEI | 1.3 (1.0, 1.5) | 1.1 (1.1, 1.3) | 0.158 |
TV s’, cm/s | 12.0 (9.0, 13.0) | 11.2 (10.1, 11.6) | 0.608 |
PASP/TAPSE, mmHg/cm | 44.3 ± 14.4 | 44.4 ± 16.3 | 0.975 |
Blood gas analysis | |||
pH | 7.39 (7.35, 7.42) | 7.40 (7.38, 7.42) | 0.189 |
PaO2, mmHg | 58 (46, 60) | 59.5 (50.8, 69.5) | 0.591 |
PaCO2, mmHg | 50.3 (39.7, 60.1) | 46.5 (37.7, 58.6) | 0.236 |
SaO2, % | 87.0 (79.3, 91.7) | 93.8 (83.1, 93.8) | 0.136 |
PAH-targeted therapy | |||
PDE5I | 47 (70.1) | 30 (90.1) | 0.127 |
ERA | 5 (7.5) | 1 (3.3) | 0.661 |
Prostacyclin | 6 (9.0) | 1 (3.3) | 0.420 |
None | 9 (13.4) | 2 (6.1) | 0.330 |
Traditional treatment | |||
Oxygen | 67 (100) | 33 (100) | 1.000 |
ICS/LABA | 59 (88.1) | 30 (90.9) | 1.000 |
Variable * | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
HR [95% CI] | p Value | HR [95% CI] | p Value | β-Coefficient | Weighted Scores | |
Age, years | 1.581 (0.779, 3.206) | 0.204 | ||||
Sex | 0.691 (0.370, 1.290) | 0.246 | ||||
BSA | 1.004 (0.263, 3.833) | 1.004 | ||||
PaO2, mm Hg | 0.983 (0.963, 1.004) | 0.119 | ||||
PaCO2, mm Hg | 1.010 (0.984, 1.036) | 0.471 | ||||
SaO2, % | 0.973 (0.940, 1.008) | 0.125 | ||||
Lactic acid, mmol/L | 1.355 (0.891, 2.062) | 0.155 | ||||
Echocardiography | ||||||
LVEF, % | 0.531 (0.223, 1.268) | 0.154 | ||||
LA, cm | 0.666 (0.350, 1.265) | 0.214 | ||||
LVDED, cm | 0.608 (0.310, 1.193) | 0.148 | ||||
LVSED, cm | 0.408 (0.220, 0.756) | 0.004 | ||||
RATD, cm | 0.485 (0.201, 1.168) | 0.107 | ||||
RALD, cm | 1.588 (0.809, 3.118) | 0.179 | ||||
RVEDTD, cm | 2.583 (1.311, 5.091) | 0.006 | 2.248 (1.062, 4.759) | 0.034 | 0.810 | 1 |
RVEDLD, cm | 1.363 (0.738, 2.519) | 0.322 | ||||
PASP, mmHg | 2.599 (1.232, 5.485) | 0.012 | 5.039 (2.002, 12.680) | 0.001 | 1.617 | 2 |
TAPSE, cm | 0.514 (0.273, 0.969) | 0.040 | 0.414 (0.196, 0.873) | 0.021 | −0.882 | −1 |
PAd, cm | 0.537 (0.253, 1.295) | 0.181 | ||||
ENDSEI | 2.342 (1.071, 5.123) | 0.033 | ||||
Pulmonary function test | ||||||
FEV1% pred | 0.753 (0.390, 1.455) | 0.399 | ||||
FVC% pred | 0.674 (0.362, 1.257) | 0.215 | ||||
FEV1/FVC | 0.427 (0.202, 0.904) | 0.026 | ||||
RV% pred | 1.197 (0.615, 2.330) | 0.597 | ||||
TLC% pred | 1.354 (0.660, 2.780) | 0.409 | ||||
DLco% pred | 0.437 (0.217, 0.879) | 0.020 |
Variables | Value |
---|---|
TAPSE ≥ 1.8 cm | −1 |
LVSED < 2.3 cm | 0 |
RVEDTD ≥ 4.2 cm | +1 |
RVEDTD < 4.2 cm | 0 |
PASP ≥ 103 mm Hg | +2 |
PASP < 103 mm Hg | 0 |
Total Scores | −1~3 |
Variable * | HR [95% CI] | p Value |
---|---|---|
Lactic acid, mmol/L | 2.877 (1.103, 7.503) | 0.031 |
Echocardiography | ||
LVSED, cm | 0.460 (0.231, 0.915) | 0.027 |
RVEDTD, cm | 3.708 (1.156, 9.069) | 0.004 |
PASP, mmHg | 1.432 (0.717, 2.858) | 0.309 |
TAPSE, cm | 2.040 (0.986, 4.218) | 0.055 |
ENDSEI | 2.267 (1.121, 4.587) | 0.023 |
Pulmonary function test | ||
FVC% pred | 0.467 (0.226, 0.966) | 0.040 |
FEV1/FVC | 0.473 (0.224, 0.997) | 0.049 |
DLco% pred | 0.260 (0.100, 0.676) | 0.006 |
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Jiang, R.; Wang, L.; Zhao, Q.-H.; Wu, C.; Yuan, P.; Wang, S.; Zhang, R.; Gong, S.-G.; Wu, W.-H.; He, J.; et al. Echocardiography Nomogram for Predicting Survival among Chronic Lung Disease Patients with Severe Pulmonary Hypertension. J. Clin. Med. 2022, 11, 1603. https://doi.org/10.3390/jcm11061603
Jiang R, Wang L, Zhao Q-H, Wu C, Yuan P, Wang S, Zhang R, Gong S-G, Wu W-H, He J, et al. Echocardiography Nomogram for Predicting Survival among Chronic Lung Disease Patients with Severe Pulmonary Hypertension. Journal of Clinical Medicine. 2022; 11(6):1603. https://doi.org/10.3390/jcm11061603
Chicago/Turabian StyleJiang, Rong, Lan Wang, Qin-Hua Zhao, Cheng Wu, Ping Yuan, Shang Wang, Rui Zhang, Su-Gang Gong, Wen-Hui Wu, Jing He, and et al. 2022. "Echocardiography Nomogram for Predicting Survival among Chronic Lung Disease Patients with Severe Pulmonary Hypertension" Journal of Clinical Medicine 11, no. 6: 1603. https://doi.org/10.3390/jcm11061603
APA StyleJiang, R., Wang, L., Zhao, Q. -H., Wu, C., Yuan, P., Wang, S., Zhang, R., Gong, S. -G., Wu, W. -H., He, J., Qiu, H. -L., Luo, C. -J., Liu, J. -M., & Jing, Z. -C. (2022). Echocardiography Nomogram for Predicting Survival among Chronic Lung Disease Patients with Severe Pulmonary Hypertension. Journal of Clinical Medicine, 11(6), 1603. https://doi.org/10.3390/jcm11061603