Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload.
Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload.
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DOI：
10.1016/j.amjcard.2021.08.016
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发表时间：
2021-11-15
影响因子：
2.8
通讯作者：
Wolf, Myles
中科院分区：
文献类型：
--
作者：
Edmonston, Daniel L.;Matsouaka, Roland;Shah, Svati H.;Rajagopal, Sudarshan;Wolf, Myles
容量过载通过肺静脉高压促进肺动脉高压（PH）。然而，PH伴肺血管阻力升高（以下简称PH- pvr）可能发生在容量超载疾病（如心力衰竭或慢性肾脏疾病（CKD））患者中。在这种情况下，仅靠容积管理可能不足以减缓PH的进展。一种准确、无创的方法来筛查这些疾病的PH-PVR，将有助于早期靶向治疗。我们整合了从单中心临床队列收集的有创血流动力学和超声心动图数据，并在评估时确定了CKD或心力衰竭患者。我们应用惩罚回归来获得与PH-PVR相关的临床参数和超声心动图数据的风险评分，并将患者分为低（≤5分）、中（6-10分）或高风险（> - 10分）组。使用内部验证策略，我们评估了该风险评分预测PH-PVR的能力，并确定了该风险分类与3年全因死亡率的关系。2422例患者中，42.4%有PH-PVR。在校正分析中，三尖瓣反流速度、右心室功能、BMI、心率和血红蛋白与PH-PVR密切相关。风险评分与PH-PVR显著相关（最高风险组年龄校正优势比为11.69,95%可信区间[CI] 6.54-20.92）。在校正分析中，高危组3年全因死亡率的风险也显著增加（风险比1.85,95% CI 1.50-2.27）。总之，在一组CKD合并心力衰竭患者中，由超声心动图和临床参数得出的无创风险评分与PH-PVR和全因死亡率显著相关。
Volume overload promotes pulmonary hypertension (PH) through pulmonary venous hypertension. However, PH with elevated pulmonary vascular resistance (hereafter PH-PVR) may develop in patients with diseases of volume overload, such as heart failure or chronic kidney disease (CKD). In such cases, volume management alone may be insufficient to slow PH progression. An accurate, noninvasive method to screen for PH-PVR in these diseases would facilitate early targeted therapy. We integrated invasive hemodynamic and echocardiography data collected from a single-center clinical cohort and identified patients with CKD or heart failure at the time of assessment. We applied penalized regression to derive a risk score of clinical parameters and echocardiography data associated with PH-PVR and categorized patients into low- (≤5 points), intermediate- (6–10 points), or high-risk (>10 points) groups. Using an internal validation strategy, we evaluated the ability of this risk score to predict PH-PVR and determined the association of this risk classification with 3-year all-cause mortality. Of 2422 patients, 42.4% had PH-PVR. In adjusted analyses, tricuspid regurgitant velocity, right ventricular function, BMI, heart rate, and hemoglobin most strongly associated with PH-PVR. The risk score significantly associated with PH-PVR (age-adjusted odds ratio 11.69 for the highest-risk group, 95% confidence interval [CI] 6.54–20.92). The high-risk group also associated with a significantly higher risk of 3-year all-cause mortality in adjusted analyses (hazard ratio 1.85, 95% CI 1.50–2.27). In conclusion, a noninvasive risk score derived from echocardiography and clinical parameters significantly associated with PH-PVR and all-cause mortality in a cohort of patients with CKD and heart failure.
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DOI：
10.1161/circimaging.112.976654
发表时间：
2012-11
期刊：
Circulation. Cardiovascular imaging
影响因子：
--
作者：
Opotowsky AR;Ojeda J;Rogers F;Prasanna V;Clair M;Moko L;Vaidya A;Afilalo J;Forfia PR
通讯作者：
Forfia PR
影响因子：
2.6
作者：
Al-Naamani N;Paulus JK;Roberts KE;Pauciulo MW;Lutz K;Nichols WC;Kawut SM
通讯作者：
Kawut SM
影响因子：
3.5
作者：
Krasuski, Richard A.;Hart, Stephen A.;Bashore, Thomas M.
通讯作者：
Bashore, Thomas M.
影响因子：
4.1
作者：
Hsieh, Anthony Y. Y.;Budd, Matthew;Cote, Helene C. F.
通讯作者：
Cote, Helene C. F.
影响因子：
9.6
作者：
Badesch, David B.;Raskob, Gary E.;McGoon, Michael D.
通讯作者：
McGoon, Michael D.