Correlation Between Tiffeneau–Pinelli Index and Mean Pulmonary Arterial Pressure

in Atrial Septal Defect Patient

PRADIPTA Leo Deddy1, ALAMSYAPUTRA Adwin1, FARISSA Inne Pratiwi1, UDDIN
Ilham1
1
Dr. Kariadi Central General Hospital, Semarang, Indonesia

OBJECTIVES
The objective of this research was to analyze the correlation between Tiffeneau-Pinelli index
and mean pulmonary arterial pressure (mPAP).
MATERIALS AND METHODS
This study was a-single center, retrospective study, included adult patients with atrial septal
defect underwent closure surgery between Januari – December 2022. Forced Expiratory
Volume in the 1st second (FEV1) and Forced Vital Capacity (FVC) calculation was performed
by using spirometry, several weeks before operation. All procedures were performed
according to 2019 ATS/ERS standardization of spirometry. FEV1/FVC ratio was divided into
severe (ratio <50%) and not severe (ratio > 50%). Right heart catheterization (RHC) indices,
including mPAP, flow ratio, and Pulmonary Arterial Resistance Index (PARI), were recorded.
RESULTS
A total of 32 patients (34 + 14 years, 33% men) were enrolled. Of 32 patients, 18 patients
have mPAP <40 mmHg and 14 patients have mPAP >40 mmHg. Patient with higher mPAP
have significantly lower FEV1 and FVC, p 0.03 and p 0.02, respectively. FEV1/FVC ratio was
lower in patient with higher mPAP as well which means that patient with higher mPAP tend
to have severe restrictive lung defect. There is statistically strong correlation between
Tiffeneau–Pinelli Index and mPAP (r 0.489 and p 0.002).
CONCLUSION
Tiffeneau-Pinelli index have strong correlation with mPAP in patient with ASD. Low
Tiffeneau-Pinelli index is associated with higher mean pulmonary arterial pressure and vice
versa.
  Mean Pulmonary Artery Pressure
Total (n = > 40 mmHg (n = p
  <40 mmHg (n = 18)
32) 14)
Characteristics
Age (in years) 34 + 14 36 + 13 33 + 15 0.51
Gender 0.69
Male 8 4 4
Female 24 14 10
47.97 + 0.49
Body Weight (kg) 49.22 + 10.12 46.36 + 13.29
11.51
Body Height (cm) 158 + 7.5 157.67 + 6.53 158.43 + 8.84 0.78
Body Mass Index 0.27
19.09 + 3.7 19.73 + 3.47 18.26 + 3.95
(kg/m2)
Body Surface Area 1.44 + 0.19 1.46 + 0.17 1.42 + 0.22 0.52
Spirometry Result
FEV1 (mL) 1558 + 684 1782 + 666 1270 + 613 0.03
FVC (mL) 1689 + 744 1940 + 721 1365 + 663 0.02
Echocardiography
ASD Diameter (mm) 26.81 + 8.12 24.61 + 6.53 29.64 + 9.28 0.08
LVEF (%) 67.3 + 8.77 67.72 + 9.45 66.75 + 8.14 0.76
TAPSE (mm) 24.41 + 5.33 25.78 + 4.87 22.64 + 5.54 0.09
Estimated PCWP 0.11
12.76 + 3.65 11.86 + 3.12 13.93 + 4.06
(mmHg)
Right Heart
Catheterization
Flow Ratio 2.69 + 1.32 2.6 + 1.48 2.8 + 1.13 0.68
PARI 3.39 + 2.63 2.28 + 1.83 4.8 + 2.88 0.005
<0.00
mPAP (mmHg) 36.25 + 16.8 24.56 + 7.31 51.29 + 13.05
1
Table 1. Patient characteristics and contingency coefficient correlation test
mPAP Correlatio p
n
Coefficient
 <40 mmHg >40 mmHg
Severe 11 4
FEV1/FVC Not 0.489 0.002
3 14
Severe