A novel scoring index by Doppler echocardiography for predicting severe pulmonary hypertension due to chronic lung diseases: a cross-sectional diagnostic accuracy study

Abstract

BackgroundSevere pulmonary hypertension (PH) resulting from a chronic lung disease (CLD) (severe CLD-PH) requires more aggressive treatment due to its increased mortality compared with mild PH. Therefore, we developed a Doppler echocardiography scoring index (ESI) to predict severe CLD-PH.MethodsA derivation cohort of 107 patients with CLD who underwent echocardiography was classified into two groups, the normal/mild PH group and the severe PH group, based on the right heart catheterization. Meanwhile, we designed the ESI by multivariate logistic regression to validate the predicted outcomes. The ESI was calculated using the following formula: ESI = ESIRVEDTD + ESIPASP + ESIPAd − ESITAPSE. Additionally, the ESI was weighted by +2 points for right ventricular end-diastolic transverse dimension ≥3.8 cm or pulmonary artery diameter ≥2.7 cm, +3 points for systolic pulmonary artery pressure (PASP) ≥61 mmHg, and −3 points for tricuspid annular plane systolic excursion ≥1.65 cm.ResultsIn the derivation cohort, PASP ≥61 mmHg estimated by echocardiography exhibited 80.4% sensitivity and 84.3% specificity with area under receiver-operating characteristic curve of 0.823 (95% CI: 0.797–0.942, P<0.0001). Compared with PASP, ESI ≥1.0 exhibited 91.1% sensitivity and 80.4% specificity, resulting in a net improvement in model performance with a change in the c-statistic from 0.823 to 0.937 and an integrated discrimination improvement of 11.3% (95% CI: 4.5%–18.2%, P=0.001). The ESI was applied to the validation cohort, resulting in 84.2% sensitivity and 81.3% specificity with 82.9% accuracy.ConclusionThe ESI showed high capacity for predicting severe CLD-PH, further implying the value of noninvasive examinations in clinic.

Survival in severe pulmonary hypertension due to chronic lung disease: influence of in‐hospital platelet distribution width

“…Progressively activated platelets with pseudopodia formation have heterogeneous sizes and may increase PDW accordingly. 16,17 The association of PDW with survival may be hypothetically linked with hypercoagulation, which plays a significant role in conditions associated with survival in COPD 18 and acute myocardial infarction. 19,20 Previously, PDW was found to increase in tumors (cervical and hepatocellular carcinoma, 21,22 breast and gastric cancer 23,24 ) and inflammatory disorders (sepsis 25 and acute pancreatitis 26 ) and was identified as a predictor for survival.…”

“…Transthoracic echocardiography was performed as described previously. 16 Blood samples. Blood samples were obtained in the nonfasting state on the second day after admission to the hospital.…”

Right cardiac involvement in lung diseases: a multimodality approach from diagnosis to prognostication

“…Nevertheless, Jiang et al reported that a multiparametric echocardiographic approach has a good diagnostic accuracy in predicting severely augmented sPAP in patients with COPD and PH [33]. PH grading according to invasive and noninvasive measures of pulmonary artery pressures is shown in Table 2 [33,34]. In fact, increased sPAP values can be indirectly estimated by other RV parameters.…”

“…According to some Authors [31,32], in case of increased pulmonary pressure the non-invasive measurement of sPAP is less accurate than the gold-standard method. Nevertheless, Jiang et al reported that a multiparametric echocardiographic approach has a good diagnostic accuracy in predicting severely augmented sPAP in patients with COPD and PH [33]. PH grading according to invasive and noninvasive measures of pulmonary artery pressures is shown in Table 2 [33,34].…”

Survival in Severe Pulmonary Hypertension Due to Chronic Lung Disease: Influence of In-Hospital Platelet Distribution Width

“…The heart rate and the transcutaneous arterial oxygen saturation were monitored continuously. Transthoracic echocardiography was underdone as described previously [13].…”