Results
A total of 72 patients undergoing RHC were included in this study.
Patients included 34 cases of atrium septal defect (ASD), 24 cases of
ventricular septal defect (VSD) and 14 cases of patent ductus arteriosus
(PDA).
Patients were divided in three groups based on mPAP and RV function as
follows; group 1: patients with PHTN without significant RV dysfunction
(n=25), group 2: patients with PHTN with significant RV dysfunction
(n=22), group 3: patients with normal PAP (n=25). Mean age of the
subjects was 40.90 ± 13.28 years old. There was no significant
difference between groups in terms of age (p=0.726). Majority of
subjects were female (51, 70.8%). There was no significant difference
between groups in terms of gender distribution (p=0.553). Comparison of
the echocardiographic findings of the study subjects are presented in
Table 1. There was a significant difference in terms of A/S
(p<0.001) between group 1 and 3. There was a significant
difference in terms of S velocity(p=0.021), D (p=0.010), S/(S+D)
(p<0.001), S/D (p<0.001) and S/D (p<0.001)
between group 2 and 3. There was a significant difference in terms of S
velocity (p<0.001), D velocity (p=0.010), S/(S+D)
(p<0.001), and S/D between group 1 and 2.
The multinomial logistic regression was used to assess the relationship
between PHTN and echocardiography parameters with control group as
reference. The analysis revealed a significant relationship between A
velocity and PHTN among patients with significant RV dysfunction
(p=0.033) and PHTN without significant RV dysfunction (p=0.020). At
cut-off value of 39.5 cm/s, A velocity could detect PHTN with
significant RV dysfunction with sensitivity and specificity of 77.3%
and 56.0%, respectively. At cut-off value of 38.5 cm/s, A velocity
could detect PHTN without significant RV dysfunction with sensitivity
and specificity of 76.0% and 51.0%, respectively.
The ROC curve analysis was performed to assess the sensitivity of
systolic filling fraction (S/S+D )in detecting normal SPAP in the study
population. The area under curve was 0.718. Considering the cut-off
value of 0.535 for systolic filling fraction, the sensitivity and
specificity of S/S+D for detecting normal SPAP were 80% and 64%,
respectively (Figure 1).