背景:根据最新的肺动脉高压(PH)指南,经胸超声心动图(TTE)的主肺动脉(MPA)直径>25mm支持诊断PH。然而,肺动脉(PA)的大小可能会根据身体大小而变化,年龄,和心脏相位。
目标:1)TTE上PA大小的参考限制是什么,考虑到身体大小的差异,性别,和年龄?2)PA大小对肺动脉高压分类的诊断价值是什么?3)选择不同的参考组(健康志愿者与接受右心导管检查(RHC)的患者)如何影响诊断比值比(DOR)?
方法:该研究包括248名健康个体作为对照的参考队列,通过RHC证实的693名PH患者,和156例经RHC证实的非PH患者。在PH队列中,300人患有第1组PH,207名患有第2组PH,和186与组-3PH。在胸骨上部短轴和胸骨上切迹视图中测量MPA和右PA(RPA)直径和面积。参考限值(第5-95百分位数)基于绝对值和身高指数测量值。分位数回归分析用于得出PA测量的中值和第95分位数参考方程。然后使用健康对照和非PH队列确定PH的DOR和概率诊断图。
结果:两种性别的MPA指数直径的第95百分位数在舒张期为15mm/m,收缩期为19mm/m。分位数回归分析显示年龄效应较弱(MPA直径的伪R2为0.08至0.10)。在措施中,舒张期的MPA大小有最高的DOR,156.2(68.3-357.5),用于检测组-1PH。同样,与对照组相比,2组和3组PH的DORs也较高,但与非PH队列相比显著较低.
结论:该研究提出了基于高度索引和分位数回归的MPA的新参考极限。
BACKGROUND: According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter > 25 mm on transthoracic echocardiography supports the diagnosis of PH. However, the size of the pulmonary artery (PA) may vary according to body size, age, and cardiac phases.
OBJECTIVE: (1) What are the reference limits for PA size on transthoracic echocardiography, considering differences in body size, sex, and age? (2) What is the diagnostic value of the PA size for classifying PH? (3) How does the selection of different reference groups (healthy volunteers vs patients referred for right heart catheterization [RHC]) influence the diagnostic OR (DOR)?
METHODS: The study included a reference cohort of 248 healthy individuals as control patients, 693 patients with PH proven by RHC, and 156 non-PH patients proven by RHC. In the PH cohort, 300 had group 1 PH, 207 had group 2 PH, and 186 had group 3 PH. MPA and right PA diameters and areas were measured in the upper sternal short-axis and suprasternal notch views. Reference limits (5th-95th percentile) were based on absolute values and height-indexed measures. Quantile regression analysis was used to derive median and 95th quantile reference equations for the PA measures. DORs and probability diagnostic plots for PH were then determined using healthy control and non-PH cohorts.
RESULTS: The 95th percentile for indexed MPA diameter was 15 mm/m in diastole and 19 mm/m in systole in both sexes. Quantile regression analysis revealed a weak age effect (pseudo-R2 of 0.08-0.10 for MPA diameters). Among measures, the MPA size in diastole had the highest DOR (156.2; 95% CI, 68.3-357.5) for detection of group 1 PH. Similarly, the DORs were also high for groups 2 and 3 PH when compared with the control cohort but significantly lower compared with the non-PH cohort.
CONCLUSIONS: This study presents novel reference limits for MPA based on height indexing and quantile regression.