Wonisch Manfred, Fruhwald Friedrich M, Maier Robert, Watzinger Norbert, Hödl Ronald, Kraxner Wilfried, Perthold Wolfgang, Klein Werner W
Department of Medicine, Division of Cardiology, Medical University, Graz, Austria.
Int J Cardiol. 2005 Jun 8;101(3):415-20. doi: 10.1016/j.ijcard.2004.03.054.
Right heart haemodynamic parameters can be recorded continuously with the help of an implanted haemodynamic monitor. Aim of the study was to assess the haemodynamic response with and without inhalation of iloprost during cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension.
Five female patients with documented pulmonary hypertension (mean +/- S.D. age 47 +/- 16 years, 4 arterial, 1 venous) previously implanted with a haemodynamic monitor underwent an incremental exercise test on 2 separate days. The tests were performed before and immediately after inhalation of a single dose of iloprost (17 microg). Parameters recorded by the device were right ventricular (RV)-afterload (RV systolic pressure, RVSP), RV-preload (RV diastolic pressure, RVDP), estimated pulmonary artery diastolic pressure (ePAD), heart rate (HR) and maximum positive rate of RV pressure development (RVdP/dt) (reflecting the dynamic and inotropic state of the RV).
After inhalation of iloprost, RV systolic pressure was always reduced at rest. It was followed by an increase with higher workloads without any difference at VO(2peak). The time course of RV systolic pressure was not linear with a flattening at higher workload during the test. This behaviour was found irrespective of iloprost treatment. The remaining determinants of RV performance showed no relevant differences and a linear behaviour during the exercise test.
Inhalation of aerosolised iloprost resulted in a reduction in right ventricular pressure at rest but not at maximal workload. The implantable haemodynamic monitor (IHM) may be useful for the evaluation of RV haemodynamics during exercise and in assessing treatment efficacy.
借助植入式血流动力学监测器可连续记录右心血流动力学参数。本研究的目的是评估肺动脉高压患者在心肺运动试验（CPET）期间吸入伊洛前列素与未吸入伊洛前列素时的血流动力学反应。
5名有肺动脉高压记录的女性患者（平均±标准差年龄47±16岁，4例动脉性，1例静脉性），此前已植入血流动力学监测器，在2个不同日期进行了递增运动试验。试验在吸入单剂量伊洛前列素（17微克）之前和之后立即进行。该设备记录的参数包括右心室（RV）后负荷（RV收缩压，RVSP）、RV前负荷（RV舒张压，RVDP）、估计肺动脉舒张压（ePAD）、心率（HR）和RV压力上升最大正速率（RVdP/dt）（反映RV的动态和变力状态）。
吸入伊洛前列素后，静息时RV收缩压总是降低。随后随着工作量增加而升高，在VO₂峰值时无差异。RV收缩压的时间进程在试验中不是线性的，在较高工作量时趋于平稳。无论伊洛前列素治疗与否，均发现这种情况。RV功能的其余决定因素在运动试验期间无相关差异且呈线性变化。
雾化吸入伊洛前列素可使静息时右心室压力降低，但在最大工作量时无此效果。可植入式血流动力学监测器（IHM）可能有助于评估运动期间的RV血流动力学及评估治疗效果。
