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MRI在评估PAH病人预后时具有一定的预测准确度根据一项最新发表在American Journal of Respiratory and Critical Care Medicine上的文章,磁共振成象(MRI)能够预测肺动脉高血压(PAH)病人的预后结果。 来自英国谢菲尔德大学的Andrew J. Swift博士及其同事研究了576个患PAH并进行MRI检测的病人,测试后跟踪调查了42个月,这些人群被分为两组:回顾组(288个病人,115人死亡)和验证组(288个病人,105人死亡)。 研究人员发现根据年龄、性别及肺动脉相对面积变化校正后的右心室(RV)收缩末期容积指数是独立的MRI死亡预测指标。根据回顾组数据,研究人员建立的一个基于MRI数据与临床数据的模型,该模型可以预测验证组试验者在1年后(灵敏度,70,特异性,62,阳性预测值[PPV],24,阴性预测值[NPV],92)和3年后(灵敏度,77,特异性,73,阳性预测值[PPV],56,阴性预测值[NPV],87)的死亡率。该模型对于先天性PAH病人在3年后的死亡率预测准确性更高(灵敏度,89,特异性,76,阳性预测值[PPV],60,阴性预测值[NPV],94)。 “反应RV结构和近端肺血管的刚性的MRI检测指标是独立的PAH病人结果预测因子。”作者在文中写道,“和临床数据结合在一起,MRI在评估PAH病人预后时具有一定的预测准确度。” Abstract: Rationale: Prognostication is important when counselling patients and defining treatment strategies in pulmonary arterial hypertension (PAH). Objective: To determine the value of MRI metrics for prediction of mortality in PAH. Methods: Consecutive patients with PAH undergoing MRI were identified from the ASPIRE-Pulmonary-Hypertension-Registry. Measurements and main results: During the follow-up period of 42 (range 17-142) months 576 patients were studied and 221 (38%) died. A derivation cohort (n=288, 115 deaths) and validation cohort (n=288, 106 deaths) were identified. We used multivariate Cox regression and found two independent MRI predictors of death (P<0.01); RV-end-systolic-volume index adjusted for age and sex (RVESVI%pred) and the relative area change of the pulmonary artery. A model of MRI and clinical data constructed from the derivation cohort predicted mortality in the validation cohort at 1 year: sensitivity 70 (95% CI 53-83), specificity 62 (95% CI 62-68), positive predictive value (PPV) 24 (95% CI 16-32) and negative predictive value (NPV) 92 (95% CI 87-96) and at 3 years: sensitivity 77 (95% CI 67-85), specificity 73 (95% CI 66-85), PPV 56 (95% CI 47-65) and NPV 87 (95% CI 81-92). The model was more accurate in patients with IPAH at 3 years (sensitivity 89 (95% CI 65-84), specificity 76 (95% CI 65-84), PPV 60 (95% CI 46-74) and NPV 94 (95% CI 85-98)) Conclusion: MRI measurements reflecting RV structure and stiffness of the proximal pulmonary vasculature are independent predictors of outcome in PAH. In combination with clinical data MRI has moderate prognostic accuracy in the evaluation of patients with PAH.
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肺动脉高压
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