基于超声心动图测量的标准化肺动脉指数对法洛四联症根治术患者预后的预测价值

目的应用超声心动图测量标准化肺动脉指数,探讨其在预测法洛四联症(TOF)根治术患者预后中的临床价值。方法回顾性分析在我院行TOF根治术的465例患者资料,术前应用超声心动图测量并计算肺动脉瓣环Z值(PVAZ)、肺动脉主干Z值(MPAZ)及Nakata指数。绘制受试者工作特征(ROC)曲线预测TOF患者术中是否行跨瓣环补片(TAP),并计算敏感性、特异性、曲线下面积(AUC)及95%可信区间(CI)。采用Spearman相关性分析法分析PVAZ、MPAZ及Nakata指数与围术期临床指标的相关性;利用ROC曲线确定参数的截断值,按截断值分组后分别进行Log-Rank检验比较组间生存差异并绘制Kaplan-Meier生存曲线。结果465例行TOF根治术的患者中,413例(88.82%)术中行TAP。行TAP患者PVAZ小于未行TAP患者-2.81(-3.31,-2.04)vs.-1.51(-2.52,-0.75)],差异有统计学意义(P<0.001)。ROC曲线分析显示,PVAZ截断值为-2.73,预测术中行TAP的曲线下面积为0.740(95%CI:0.641~0.839),敏感性为52.8%,特异性为86.0%。PVAZ、MPAZ及Nakata指数与围术期临床指标均呈负相关。随访期间共23例死亡(4.95%),中位随访时间为2.03年。ROC曲线分析显示,PVAZ、MPAZ预测患者术后生存的截断值分别为-2.98、-3.47,PVAZ<-2.98者术后生存率显著低于PVAZ≥-2.98者,MPAZ<-3.47者术后生存率显著低于MPAZ≥-3.47者,差异均有统计学意义(P=0.044、0.002)。结论基于超声心动图测量的标准化肺动脉指数是评价TOF根治术患者预后的良好预测指标,对临床危险分层具有一定的指导意义。

Application of standardized pulmonary indexes based on echocardiography to predict the prognosis of repaired tetralogy of Fallot

Objective To explore the value of standardized pulmonary indexes based on echocardiography in the prediction of the prognosis of repaired tetralogy of Fallot (TOF). Methods 465 TOF patients who underwent complete repair from 2003 to 2020 in our hospital were included, pulmonary valve annulus Z-score (PVAZ), main pulmonary artery Z-score (MPAZ) and Nakata index were calculated based on echocardiographic evaluation. The postoperative outcomes were followed up. Receiver operating characteristic (ROC) curve was used to predict the practice of transannular patch (TAP). Correlation analysis was performed between the pulmonary indexes and clinical data during perioperative management. ROV curve was again used to confirm best cut-off values and conduct survival analysis. Results A total of 413 cases (88.8%) underwent TAP during complete repair. For the practice of TAP, when PVAZ=-2.725, area under the curve (AUC)=0.740, sensibility=0.528, specificity=0.860. MPAZ and Nakata index turned out to be well-related to the perioperative results, with lower MPAZ and Nakata index indicating longer time of operation and postoperative care. There were 23 cases (4.95%) of death during a median follow-up time of 2.03 years. PVAZ=-3 and MPAZ=-3.5 were confirmed as the cut-off values and the survival differences between the groups were statistically significant. Conclusion Standardized pulmonary indexes based on echocardiographic evaluation are good indicators to predict the prognosis of repaired TOF, which may be of great guiding significance in the clinical hazard stratification.