Application Of Echocardiography In The Assessment Of Global Heart Function In Non-left Heart Disease Related Pulmonary Hypertension

BackgroundPulmonary hypertension is realted to various diseases that characterized by pulmonary average arterial pressure≥25 mmHg,which may ultimately lead to right heart failure and death.Pulmonary hypertension has a high mortality and disability rate,and the clinical outcome of patients mainly depends on early diagnosis,the severity of the disease,and response to medicine treatment.In the last decades,researchers were trying to figure out the pathogenesis of patients with pulmonary hypertension.Many kinds of biomarkers and factors were found to predict the prognosis of patients and evaluate treatment effects in order to improve clinical outcomesNormarlly,researchers thought that pulmonary hypertension mainly changed the function of the right heart.However,recent studies suggested that pulmonary hypertension might not only changes right heart function and structure of patients,but also that of left heart,which might provide a new direction of predictive modelsObjectiveThe objective of this study was to determine whether the indicators of left heart were related to the patients’prognosis.What’s more,three different predictive models(left heart,right heart,and global heart function)were established and further evaluated,which was hoped to select the best predictive model that could predict the patient’s prognosis in the early clinical stage.MethodPatients which were diagnosed as non-left heart diseases related pulmonary hypertension in our hospital from January 2018 to December 2018 were included in our study.The characteristic of patients including age,gender,co-existing disorders,hospitalization,clinical outcomes,and echocardiography were collected and analyzed The inclusion criteria refer to the 2015 Guidelines for the diagnosis and treatment of pulmonary hypertension:the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology and the European Respiratory Society.By analyzing these data,three different predictive models were further established.And then the receiver’s operating charcteristic curves and the decision curve analysis were conducted to evaluate the clinical value of these three models.ResultAll patients’ demographic variables,clinical manifestations and imaging examination were collected and analyzed.Among them,the aortic diameter,pulmonary artery diameter,interventricular septum,and Left ventricular posterior wall all had statistically significant differences between the survivor group(n=126)and the death group(n=54).Receiver operating curve and Decesion curve analysis were futher conducted to evaluated these three models,it is found that the AUC of the right-heart predictive model is larger than that of the left heart,which the model of global-heart was largest.The decision curve analysis showed that the net benefit of the global heart model was best between threshold probability of 0-50%.