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Evaluating Cardiac Lateralization by MRI to Simplify Estimation of Cardiopulmonary Impairment in Pectus Excavatum
Tariq Abu-Tair1,2, Salmai Turial3, Ines Willershausen4
1Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany.
Insights
Cardiac lateralization improves pectus excavatum assessment. Measuring pulmonary valve position alongside Haller Index (HI) and Correction Index (CI) offers a more accurate picture of cardiopulmonary impairment in pectus excavatum (PE) patients.
Area of Science:
- Cardiology
- Radiology
- Thoracic Surgery
Background:
- Pectus excavatum (PE) severity is often assessed using the Haller Index (HI) and Correction Index (CI).
- These indices primarily measure chest depth, potentially underestimating cardiopulmonary impairment.
- Accurate assessment is crucial for effective treatment planning in PE patients.
Purpose of the Study:
- To evaluate MRI-derived cardiac lateralization for improved cardiopulmonary impairment estimation in PE.
- To investigate the correlation between cardiac position and cardiopulmonary function.
- To enhance existing pectus excavatum severity indices (HI and CI).
Main Methods:
- Retrospective cohort study of 113 pectus excavatum patients.
- Diagnosis confirmed via cross-sectional MRI using HI and CI.
- Cardiopulmonary exercise testing and MRI-derived pulmonary valve lateralization were used to develop improved indices.
Main Results:
- Significant correlation found between heart lateralization and PE severity (p ≤ 0.001).
- Modified HI and CI, incorporating pulmonary valve position, showed increased sensitivity and specificity.
- These enhanced indices better predicted reduced cardiac function, indicated by maximum oxygen-pulse.
Conclusions:
- Indexed lateral deviation of the pulmonary valve is a valuable addition to HI and CI.
- This approach provides a more precise description of cardiopulmonary impairment in PE.
- Improved assessment can lead to better patient management and outcomes.
Background:
The severity of pectus excavatum is classified by the Haller Index (HI) and/or Correction Index (CI). These indices measure only the depth of the defect and, therefore, impede a precise estimation of the actual cardiopulmonary impairment. We aimed to evaluate the MRI-derived cardiac lateralization to improve the estimation of cardiopulmonary impairment in Pectus excavatum in connection with the Haller and Correction Indices.
Methods:
This retrospective cohort study included a total of 113 patients (mean age = 19.03 ± 7.8) with pectus excavatum, whose diagnosis was verified on cross-sectional MRI images using the HI and CI. For the development of an improved HI and CI index, the patients underwent cardiopulmonary exercise testing to assess the influence of the right ventricle's position on cardiopulmonary impairment. The indexed lateral position of the pulmonary valve was utilized as a surrogate parameter for right ventricle localization.
Results:
In patients with PE, the heart's lateralization significantly correlated with the severity of pectus excavatum (p ≤ 0.001). When modifying HI and CI for the individual's pulmonary valve position, those indices are present with greater sensitivity and specificity regarding the maximum oxygen-pulse as a pathophysiological correlate of reduced cardiac function (χ2 10.986 and 15.862, respectively).
Conclusion:
The indexed lateral deviation of the pulmonary valve seems to be a valuable cofactor for HI and CI, allowing for an improved description of cardiopulmonary impairment in PE patients.
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