Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model
Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model
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DOI：
10.1111/j.1365-2982.2012.01952.x
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发表时间：
2012-08-01
影响因子：
3.5
通讯作者：
Pandolfino, J. E.
中科院分区：
文献类型：
--
作者：
Lin, Z.;Kahrilas, P. J.;Pandolfino, J. E.
背景综合舒张压（IRP）是芝加哥运动障碍分类中用于评估食管胃连接部（EGJ）舒张充分性的食管压力地形图（EPT）指标。然而，由于IRP值也受远端食管收缩力的影响，我们假设其正常范围应随收缩力的不同模式而变化。方法选择522篇EPT研究，比较替代分析范式与动力学专家（金标准）的准确性。人工对芝加哥分类度量进行评分，并用作MATLAB（TM）程序的输入，该程序利用严格的基于算法的解释（15 mmHg的固定异常IRP阈值）或分类和回归树（CART）模型，该模型根据相关的食管收缩性选择可变IRP阈值。关键结果CART模型对贲门失弛缓症的敏感性（93%）优于基于算法的方法（85%），因为使用了可变IRP阈值，其范围从>10 mmHg的低值（用于区分I型贲门失弛缓症与无食管痉挛）到>17 mmHg的高值（用于区分III型贲门失弛缓症与远端食管痉挛）。此外，II型贲门失弛缓症仅通过全食管加压进行诊断，而没有IRP进入算法。结论和推论EPT研究的自动化解释更紧密地模仿了运动专家的IRP阈值受损EGJ松弛时，根据相关的食管收缩力的模式进行调整。CART模型建议的IRP截止值范围为10至17 mmHg。
Background The Integrated Relaxation Pressure (IRP) is the esophageal pressure topography (EPT) metric used for assessing the adequacy of esophagogastric junction (EGJ) relaxation in the Chicago Classification of motility disorders. However, because the IRP value is also influenced by distal esophageal contractility, we hypothesized that its normal limits should vary with different patterns of contractility. Methods Five hundred and twenty two selected EPT studies were used to compare the accuracy of alternative analysis paradigms to that of a motility expert (the gold standard). Chicago Classification metrics were scored manually and used as inputs for MATLAB (TM) programs that utilized either strict algorithm-based interpretation (fixed abnormal IRP threshold of 15 mmHg) or a classification and regression tree (CART) model that selected variable IRP thresholds depending on the associated esophageal contractility. Key Results The sensitivity of the CART model for achalasia (93%) was better than that of the algorithm-based approach (85%) on account of using variable IRP thresholds that ranged from a low value of >10 mmHg to distinguish type I achalasia from absent peristalsis to a high value of >17 mmHg to distinguish type III achalasia from distal esophageal spasm. Additionally, type II achalasia was diagnosed solely by panesophageal pressurization without the IRP entering the algorithm. Conclusions & Inferences Automated interpretation of EPT studies more closely mimics that of a motility expert when IRP thresholds for impaired EGJ relaxation are adjusted depending on the pattern of associated esophageal contractility. The range of IRP cutoffs suggested by the CART model ranged from 10 to 17 mmHg.