A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / compression of the
right atrium and ventricle yet their LV function is
within normal range. In the setting of normal LV
function, symptomatic PE could potentially be the
result of right heart compression causing right heart
strain. Emphasis should therefore be placed on
analyzing the presence and degree of right heart
strain in patients with symptomatic pectus
excavatum.
When assessing for a correlation between the HI, CI,
DI, or CCI together and independently with
cardiopulmonary impairment, no significant
relationships were identified. While it would be highly
advantageous for a PE severity index to correlate with
objective physiologic impairment, our data suggest
that the currently defined indices fail to do so.
Data confirming such a correlation would provide a
means to measure both the severity of deformity
and changes in functional disability in patients with
PE. We aim to analyze the correlation between the
HI and three new indices with cardiopulmonary
impairment using the cardiopulmonary exercise
test (CPET). In this study we evaluated the
correlation of the Haller, correction, depression,
and cardiac compression indices with functional
cardiopulmonary impairment using preoperative
cardiopulmonary exercise test (CPET) data. We
hypothesize that the correction and cardiac
compression indices will be strongly correlated with
physiologic impairment in patients with PE, thus
providing a novel means to measure functional
disability as a function of disease severity.
Study Design
This is a retrospective study of 71 children between
the ages of birth and 18 years of age who
underwent evaluation for corrective surgery for
pectus excavatum between 2010 and 2016 at
Phoenix Children’s Hospital. Our final sample
underwent preoperative computed tomography
(CT) or MRI scan results as well as
cardiopulmonary exercise testing. For each
patient, the HI, CI, DI, and CCI were independently
assessed using the PACS System by a single rater.
Preoperative functional capacity was determined
by measurement of peak oxygen consumption
(VO2max reported as percent predicted) and
stroke volume (a surrogate for cardiac output)
which was assessed via the O2 pulse
(VO2max/heart rate) reported as percent predicted.
The possible values range from zero to 100% of
the predicted value.
Assessments
Halller Index Correction Index
Depression Index Cardiac Compression Index
Correction, Depression, Cardiac Compression and Haller Indices Fail to Correlate with
Cardiopulmonary Impairment in Pectus Excavatum
Abstract Results
Background: Pectus excavatum (PE) affects 1 in
every 300 to 1,000 live births with a male to female
ratio of 5:1, making it the most common congenital
chest wall deformity in children. The standard for
determining disease severity has become the Haller
Index, which has been shown to poorly correlate with
physiologic impairment. Recently, more novel indices
have been introduced in an effort to more effectively
represent disease burden. We aim to analyze the
correlation between these indices and
cardiopulmonary impairment in patients with PE using chest CT/ MRI as well as preoperative
cardiopulmonary exercise testing data.
Conclusions: We found that when assessing for a
correlation between the HI, CI, DI, or CCI together and
independently with cardiopulmonary impairment, both
the linear and multiple regression models failed to
identify a statistically significant relationship. While it
would be highly advantageous for a PE severity index
to correlate with objective physiologic impairment, our
data suggest that the currently defined indices fail to do so.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/627154 |
| Date | 29 March 2018 |
| Creators | Donato, Britton |
| Contributors | The University of Arizona College of Medicine - Phoenix, Notrica, David MD |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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