左心室射血分数正常患者运动性肺动脉高压的决定因素

Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction.

作者信息

Ha J-W, Choi D, Park S, Shim C-Y, Kim J-M, Moon S-H, Lee H-J, Choi E-Y, Chung N

机构信息

Cardiology Division, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.

出版信息

Heart. 2009 Mar;95(6):490-4. doi: 10.1136/hrt.2007.139295. Epub 2008 Jul 24.

DOI:10.1136/hrt.2007.139295

PMID:18653569

Abstract

BACKGROUND

Pulmonary hypertension (PH) can occur during exercise and has an adverse effect on functional status, exercise tolerance and prognosis. However, the role of cardiac function abnormalities on exercise-induced PH in patients with normal left ventricular ejection fraction (LVEF) is unclear.

OBJECTIVE

To analyse exercise-induced PH determinants in patients with normal LVEF.

METHODS AND RESULTS

396 subjects (160 male, mean age 55 (SD 13)) referred for exercise echocardiography underwent a graded, symptom-limited, supine bicycle exercise with two-dimensional and Doppler echocardiography. Tricuspid regurgitation (TR) velocity was measured at rest and during exercise. Pulmonary artery systolic pressure (PASP) was estimated from TR velocity by adding a right atrial pressure of 10 mm Hg. Patients were classified according to exercise induced PH, defined as present if PASP >50 mm Hg at 50 W of exercise. 135 patients (34%) had PASP >50 mm Hg during exercise. Patients with exercise-induced PH were older, more commonly female and had shorter exercise duration; however, LVEF was significantly higher. The systolic blood pressure at rest and during exercise was significantly higher in patients with exercise-induced PH (rest, 125 (18) vs 132 (18) mm Hg, p = 0.0003; 25 W, 146 (21) vs 157 (21) mm Hg, p<0.0001; 50 W, 157 (24) vs 170 (22) mm Hg, p<0.0001; 75 W, 168 (23) vs 183 (22) mm Hg, p<0.0001). Despite similar resting oxygen saturation, exercise oxygen saturation was significantly lower in subjects with exercise-induced PH than in those without. Numerous echocardiographic variables were significantly different between groups. In multivariate analysis, resting TR velocity (p<0.0001), E/E' (p = 0.027), age and gender were the strongest predictors of PASP during exercise.

CONCLUSION

Exercise-induced PH is common even in subjects with normal LVEF. It is strongly associated with E/E' ratio, TR velocity, age, systolic blood pressure during exercise and gender.

摘要

背景

肺动脉高压（PH）可在运动期间发生，并对功能状态、运动耐量和预后产生不利影响。然而，左心室射血分数（LVEF）正常的患者中，心脏功能异常在运动诱发的PH中的作用尚不清楚。

目的

分析LVEF正常患者运动诱发PH的决定因素。

方法与结果

396例接受运动超声心动图检查的受试者（160例男性，平均年龄55岁（标准差13岁））进行了分级、症状限制的仰卧位自行车运动，并同时进行二维和多普勒超声心动图检查。在静息和运动期间测量三尖瓣反流（TR）速度。通过加上10 mmHg的右心房压力，根据TR速度估算肺动脉收缩压（PASP）。根据运动诱发的PH对患者进行分类，如果运动50 W时PASP>50 mmHg，则定义为存在运动诱发的PH。135例患者（34%）在运动期间PASP>50 mmHg。运动诱发PH的患者年龄更大，女性更常见，运动持续时间更短；然而，LVEF显著更高。运动诱发PH的患者静息和运动期间的收缩压显著更高（静息时，125（18）vs 132（18）mmHg，p = 0.0003；25 W时，146（21）vs 157（21）mmHg，p<0.0001；50 W时，157（24）vs 170（22）mmHg，p<0.0001；75 W时，168（23）vs 183（22）mmHg，p<0.0001）。尽管静息时氧饱和度相似，但运动诱发PH的受试者运动时的氧饱和度显著低于无运动诱发PH的受试者。两组之间的许多超声心动图变量存在显著差异。在多变量分析中，静息TR速度（p<0.0001）、E/E'（p = 0.027）、年龄和性别是运动期间PASP的最强预测因素。