| The correlation between echocardiographic right ventricular func tional and indexes plasma levelssing N-terminal pro-brain nirtie peptide in children with Pulmonary hypertension Background and Objectivesthere are a small number of studies of applicating the echocardiography an d sodium plasma N-terminal pro-brain nirtie peptide to assess right ventricular function in children with Pulmonary hypertension and also less studies of using ROC curve to analysis right heart function index cutoff values in this countr y. In this study, the correlation of right ventricular function, namely the right ventricular pressure, right ventricular Tei index, tricuspid annular systolic ve locity,the change of right ventricular fractional and plasma NT-proBNP levels in children with Pulmonary hypertension were retrospectively analyzed using ROC curve in order to provide a new method for the diagnosis of the disease.MethodsRetrospective case series. From January2007to October2013in Samsung Hospital(Korea) and yanbian hospital,40cases of pulmonary hypertension in children with echocardiography and blood tests were retrospectively analyzed the method of calculating tricuspid transvalvular pressure was used to esti mate the maximum tricuspid regurgitation peak velocity, using the simplified Bernoulli equation△P=4V2max calculated tricuspid transvalvular pressure, namely the pressure difference between the the right atrium and the right vent ricle (△P).△P plus mean right atrial pressure are the right ventricular syst olic pressure (RVSP), the right ventricular systolic pressure=△P+right atri al pressure. Using the estimated method on Right atrial pressure. When Doppl er ultrasound find no tricuspid regurgitation or mild tricuspid regurgitation, an d right atrial size is normal, right atrial pressure can be estimated as5mmHg; When there is moderate tricuspid regurgitation, mild dilated right atrial, right atrial pressure can be estimated as10mmHg; when there is severe tricuspid re gurgitation and significantly dilated right atrial, right atrial pressure can be esti mated as15mmHg. Conventional echocardiography has been completed, obtain and store a clear apical four-chamber view and more than three consecutive c ardiac cycles of real-time image, respectively, the size of the right atrium and right ventricle size, PASP, right ventricular Tei (RVTei) index, tri-tip annulus systolic velocity (TAPSE) and right ventricular fractional area change (RVFAC) were measured. According to the RVFAC put into children with pulmonary h ypertension with right ventricular function in normal and pulmonary hypertensio n with right ventricular dysfunction group. Select the patients who accept echo cardiography and plasma NT-pro BNP same day, NT-proBNP using Roche ref erence standards, which to300pg/ml for the right heart dysfunction index. Sel ect the normal control group compared with the two groups above and these r esults were analyzed. using pearson analysis the correlation between the patient RVTei, RVFAC, PASP, TAPSE, plasma NT-proBNP concentration. And analysi s with receiver operating characteristic curve (ROC).Results(1) no statistically significant difference in RA between PAH associated wi th right ventricular function in normal and the normal control group (P>0.05), There is statistically significant difference in RA between PAH associated with right ventricular disfunction and the normal control group (P<0.05). statisti cally significant in RV between PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group (P <0.05), no significant difference in RV between PAH with right ventricular dy sfunction and normal right ventricular function group (P>0.05). statistically sig nificant in PASP between PAH with right ventricular function in normal group and the normal control group (P<0.05), statistically significant in PASP betwee n PAH with right ventricular function in normal group, PAH with right ven tricular dysfunction and normal control group (P<0.05). statistically significant in RVTei between PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group (P<0.05) no s ignificant difference in RVTei between PAH with right ventricular dysfunction a nd PAH with right ventricular function in normal (P>0.05). statistically signif icant in TAPSE between PAH with right ventricular function in normal group and normal control group (P<0.05), statistically significant in TAPSE between PAH with right ventricular function in normal group, PAH with right ventri cular dysfunction and normal control group (P<0.05). no significant differenc e in RVFAC between PAH with right ventricular function in normal and norma1control group (P>0.05), statistically significant in PASP between PAH with r ight ventricular function in normal group, PAH with right ventricular dysfun ction and normal control group (P<0.05).(2) plasma NT-proBNP concentration analysis:no significant difference t he plasma concentration of NT-proBNP between PAH with right ventricular fun ction in the normal group and the normal control group (P>0.05), statistically significant in the plasma concentration of NT-proBNP between PAH with right ventricular function in normal group, PAH with right ventricular dysfunctio n and normal control group (P<0.05)。(3) Correlative analysis:PAPS has a positive correlation with RA,(r=0.380, P<0.05), no correlation with RV.(r=0.327, P>0.05), PASP has a negative correlation with TAPSE, RVFAC (r=-0.433,-0.736, P<0.05), no c orrelation with RVTei index (r=0.177, P>0.05). RVTei index has a negative correlation with TAPSE (r=-0.482, P<0.05), no correlation with RA, RV, SP AP, RVFAC (r=-0.080,-0.180,0.177,-0.069, P>0.05). TAPSE has a negativ e correlation with SPAP, RVTei index (r=-0.433,-0.482, P<0.05), positive c orrelation with RVFAC (r=0.447, P<0.05), no correlation with RA, RV (r=-0.118,-0.,063, P>0.05). RVFAC,RV has a negative correlation with SPAP (r=-0.292,-0.736, P<0.05), positive correlation with TAPSE (r=0.447, P< 0.05). Plasma NT-proBNP concentration was positively correlated with RA, RV, SPAP (r=0.368,0.453,0.414, P<0.05), negatively correlated with TAPSE, R VFAC (r=-0.354,-0.509, P<0.05), no correlated with RVTei index (r=-0.035, P>0.05).(4) ROC curve analysis:When PASP was48.5mmHg, diagnosis of PAH with right ventricular dysfunction, the sensitivity and specificity were95.7%a nd79.4%, Youden index was0.751; When PASP was62.5mmHg, diagnosis of PAH with right heart function insufficiency, the sensitivity and specificity w ere82.6%and91.2%, Youden index was0.738; area under the ROC curve was0.948(95%CI0.896to0.999, non-parametric test P=0.000). When R VTei index was0.375, the diagnosis of PAH with right ventricular dysfunctio n,the sensitivity and specificity were86.4%and50%, Youden index was0.364; When RVTei index was0.405, diagnosis of PAH with right ventricular dy sfunction,the sensitivity and specificity were77.3%and58.8%.Youden inde x was0.361; area under the ROC curve was0.740(95%CI0.610-0.870, non-parametric test P=0.003). When TAPSE was20,04mm, diagnosis of PA H with right ventricular dysfunction, the sensitivity and specificity were95.2%and75.8%, Youden index was0.71, area under the ROC curve was0.887(95%CI0.769-0.979, non-parametric test P=0.000). When RVFAC was34.7%, the diagnosis of severe PAH with right heart failure, the sensitivity and specificity were100%and94.1%, Youden index was0.941; area under the ROC curve was0.993(95%CI0.980to1.006, non-parametric test P=0.000). When Plasma NT-proBNP concentration was240.6pg/ml, diagnosis of PAH with right ventricular dysfunction, the sensitivity and specificity were92.3%and87.5%, Youden index was0.798, area under the ROC curve was0.948(95%CI0.892-1.004, non-parametric tests P=0.000)ConclusionPatients with PAH, the plasma NT-proBNP concentrations has a connection with RVFAC, PASP, TAPSE. Patients with PAH and right ventricular dysfuncti on,the ROC curve analysis has a better diagnostic value, suggesting that plas ma NT-proBNP concentration, RVAC and TAPSE can better evaluated the rig ht heart function in children with PAH The correlation between echocardiographic right ventricular func tional indexes and plasma levelssing N-terminal pro-brain nirtie peptide in adult congenital heart disease with Pulmonary hypert ensionBackground and purposethere are a small number of studies of applicating the echocardiography an d sodium plasma N-terminal pro-brain nirtie peptide to assess right ventricular function in adults with Pulmonary hypertension and also less studies of using ROC curve to analysis right heart function index cutoff values in this country. In this study, the correlation of right ventricular function, namely the pulmo nary artery systolic pressure (PASP), right ventricular Tei (RVTei) index, systo lic tricuspid annular velocity (TAPSE) and right ventricular fractional area chan ge (RVFAC) and plasma NT-proBNP levels in adult with Pulmonary hyperte nsion were retrospectively analyzed using ROC curve in order to provide a ne w method for the diagnosis of the disease.MethodsRetrospective case series. From January2007to May2013in Samsung Hospital(Korea) and yanbian hospital,55cases of pulmonary hypertension in adult with echocardiography and blood tests were retrospectively analyzed. Co nventional echocardiography has been completed, obtain and store a clear apica1four-chamber view more than three consecutive cardiac cycles of real-time i mage, respectively, the right atrium (RA) size, right ventricular (RV) size PASP, right ventricular Tei (RVTei) index, systolic tricuspid annular velocity (TAPSE) and right ventricular fractional area change (RVFAC) were measured. the method of calculating tricuspid transvalvular pressure was used to estim ate the maximum tricuspid regurgitation peak velocity, using the simplified Be rnoulli equation△P=4V2max calculated tricuspid transvalvular pressure, na mely the pressure difference between the the right atrium and the right ventri cle (△P).△P plus mean right atrial pressure are the right ventricular systo lic pressure (RVSP), the right ventricular systolic pressure=△P+right atrial pressure. Using the estimated method on right atrial pressure. When Doppler ultrasound find no tricuspid regurgitation or mild tricuspid regurgitation, and right atrial size is normal, right atrial pressure can be estimated as5mmHg; When there is moderate tricuspid regurgitation, mild dilated right atrial, right atrial pressure can be estimated as lOmmHg; when there is severe tricuspid reg urgitation and significantly dilated right atrial, right atrial pressure can be estim ated as15mmHg. FAC is measured in the apical four-chamber view, tracings of the right ventricular isovolumic end-diastolic area (EDA) and isovolumetric contraction End Area (ESA), according to the formula, FAC=100%×(ED A-ESA)/EDA measured. Right heart failure is defined as RVFAC<35%in American Society of Echocardiography, the patients were divided to three grou ps according to this definition:PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group. S elect the normal control group compared with the two groups above and these results were analyzed. using pearson analysis the correlation between the patie nt RVTei, RVFAC, PASP, TAPSE, plasma NT-proBNP concentration. And analy sis with receiver operating characteristic curve (ROC).Results(1)No statistically significant in BMI between PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and norm al control group (P>0.05).(2) Right ventricular function analysis used Echocardiography. no statistical ly significant difference in RA between PAH associated with right ventricular f unction in normal and the normal control group (P>0.05), There is statistically significant difference in RA between PAH with right ventricular function in n ormal group, PAH associated with right ventricular disfunction and the normal control group (P<0.05). statistically significant in RV between PAH with rig ht ventricular function in normal group, PAH with right ventricular dysfunct ion and normal control group (P<0.05), significant difference in RV between PAH with right ventricular dysfunction in nomal and normal control group (P <0.05). statistically significant in PASP between PAH with right ventricular fu nction in normal group and the normal control group (P<0.05), statistically sig nificant in PASP between PAH with right ventricular function in normal group PAH with right ventricular dysfunction and normal control group (P<0.05). statistically significant in RVTei between PAH with right ventricular function-i n normal group, PAH with right ventricular dysfunction and normal control group (P<0.05) no significant difference in RVTei between PAH with right ventricular function in nomal and normal control group (P>0.05). statistically significant in TAPSE between PAH with right ventricular function in normal group and normal control group (P<0.05), statistically significant in TAPSE be tween PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group (P<0.05). no significant dif ference in RVFAC between PAH with right ventricular function in normal and normal control group (P>0.05), statistically significant in PASP between PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group (P<0.05).(3) plasma NT-proBNP concentration analysis:no significant difference th e plasma concentration of NT-proBNP between PAH with right ventricular func tion in the normal group and the normal control group (P>0,05), statistically s ignificant in the plasma concentration of NT-proBNP between PAH with right ventricular function in normal group, PAH with right ventricular dysfunction and normal control group (P<0.05)。(4) Correlative analysis:PAPS has a positive no correlation with RA,(r=0.281, P>0.05), no correlation with RV.(r=0.118, P>0.05). PASP has a negative correlation with TAPSE, RVFAC (r=-0.472.-0.404, P<0.05), no cor relation with RVTei index (r=0.116, P>0.05). RVTei index has a negative c orrelation with TAPSE, RVAC (r=-0.355,-0.396, P<0.05), no correlation w ith RA, RV, SPAP (r=0.150,0.057.0.116, P>0.05). TAPSE has a negativ e correlation with SPAP, RA, RVTei index (r=-0.472,-0.456.-0.355, P<0.05), positive correlation with RVAC (r=0.440, P<0.05), no correlation with RV (r=-0.256, P>0.05). RVFAC has a negative correlation with SPAP. RA. R V, RVTei (r=-0.404.-0.541、-0.634.-0.396, P<0.05), positive correlation w ith TAPSE (r=0.440, P<0.05). Plasma NT-proBNP concentration was positive ly correlated with RA. RV (r=0.337.0.425, P<0.05), negatively correlated with TAPSE, RVAC (r=-0.339.-0.434, P<0.05),(5) ROC curve analysis:When PASP was66.9mmHg, diagnosis of PAH with right ventricular dysfunction, the sensitivity and specificity were96.9%a nd84.6%, Youden index was0.829; area under the ROC curve was0.921(95%CI0.855-0.987, non-parametric test P=0.000). When RVTei index w as0.52, the diagnosis of PAH with right ventricular dysfunction,the sensitivity and specificity were72.7%and72.7, Youden index was0.454; When RVTe i index was0.605, diagnosis of PAH with right ventricular dysfunction,the se nsitivity and specificity were57.6%and88.6%.Youden index was0.454; ar ea under the ROC curve was0.772(95%CI0.660-0.883, non-parametric t est P=0.003). When TAPSE was20.04mm, diagnosis of PAH with right vent ricular dysfunction, the sensitivity and specificity were95.2%and75.8%, Yo uden index was0.71; When TAPSE was16.39mm, diagnosis of PAH with ri ght ventricular dysfunction,the sensitivity and specificity were95.7%and82.9%Youden index was0.786; area under the ROC curve was0.922(95%CI0.856～0.989, non-parametric test P=0.000). When RVAC was33.6%, the diagnosis of severe PAH with right heart failure, the sensitivity and specificity were100%and97.6%. Youden index was0,976:area under the ROC curve was0.993(95%CI0.993-1.007, non-parametric test P=0.000). When P lasma NT-proBNP concentration was128.75pg/ml, diagnosis of PAH with right ventricular dysfunction, the sensitivity and specificity were94.3%and85.7%, Youden index was0.687; area under the ROC curve was0.861(95%CI0.775～0.946, non-parametric tests P=0.000)ConclusionPatients with PAH, the plasma NT-proBNP concentrations has a connection with RVFAC, PASP, TAPSE. Patients with PAH and right ventricular dysfuncti on,the ROC curve analysis has a better diagnostic value, suggesting that PAS P、TPASE、RVFAC,plasma NT-proBNP concentration can better evaluated the right heart function in adult congenital heart disease with PAH... |
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