Gan C Tji-Joong, Lankhaar Jan-Willem, Westerhof Nico, Marcus J Tim, Becker Annemarie, Twisk Jos W R, Boonstra Anco, Postmus Pieter E, Vonk-Noordegraaf Anton
Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
Chest. 2007 Dec;132(6):1906-12. doi: 10.1378/chest.07-1246. Epub 2007 Nov 7.
Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.
Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10% vs 58 +/- 21%, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26%) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC <or= 16% had a worse prognosis than those with a value > 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility.
Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.
肺动脉高压（PAH）患者肺血管床总顺应性降低与死亡率增加相关。我们研究了以面积扩张性和无创评估的相对面积变化（RAC）（计算为相对横截面积变化）表示的近端肺动脉僵硬度是否可预测PAH患者的死亡率。
86名受试者接受了右心导管检查和MRI以评估面积扩张性和RAC。对患者进行了长达48个月的随访。Kaplan-Meier曲线和Cox比例风险回归分析评估了面积扩张性和RAC的预测价值。70例患者确诊为PAH，16名受试者作为对照。与对照相比，患者的近端肺动脉扩张（685±214mm²对411±153mm²，p<0.001），扩张性较小（面积扩张性=0.46±0.38×10⁻²mmHg⁻¹对3.69±1.96×10⁻²mmHg⁻¹，p<0.0001），且RAC较小（20±10%对58±21%，p<0.0001）[均值±标准差]。RAC与平均肺动脉压呈反曲线关系（R²=0.47）。18例患者（26%）死于心肺原因。肺动脉RAC≤16%的患者预后比RAC>16%的患者差（对数秩检验p<0.001）。RAC对死亡率的预测优于面积扩张性。
无创测量的肺动脉RAC可预测PAH患者的死亡率。
