Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9047, USA.
J Heart Lung Transplant. 2012 Jan;31(1):67-72. doi: 10.1016/j.healun.2011.09.003. Epub 2011 Nov 9.
Jugular venous pressure (JVP) is assessed to estimate volume status in patients with heart failure because right atrial pressure (RAP) reflects pulmonary capillary wedge pressure (PCWP). In a large cohort of heart failure patients spanning 14 years, we sought to further characterize the relationship between RAP and PCWP, including identifying temporal trends, to optimize estimates of PCWP by JVP. We also sought to determine whether the RAP to PCWP relationship impacts post-transplant mortality.
Hemodynamic data were obtained from 4,079 patients before cardiac transplantation. Elevated RAP was defined as ≥10 mm Hg and elevated PCWP ≥22 mm Hg. Hemodynamics were "concordant" when both RAP and PCWP were elevated or when both were not elevated. The frequency of concordant hemodynamics was assessed over 3 eras (1993 to 1997, 1998 to 2002, 2003 to 2007). Baseline characteristics were compared among quartiles of the ratio (RAP+1)/PCWP. The association of (RAP+1)/PCWP with 2-year mortality after cardiac transplantation was assessed using multivariate models.
The frequency of concordant hemodynamics over time was stable (74%, 72%, 73%; p = 0.4). Increasing (RAP+1)/PCWP was associated with the following variables: female gender; cardiomyopathy etiology besides ischemic or non-ischemic; prior sternotomies; and lower creatinine clearance (p < 0.01 for all). Elevated (RAP+1)/PCWP was associated with post-transplant mortality (relative risk 1.2, 95% confidence interval 1.02 to 1.37, p = 0.02).
[corrected] RAP and PCWP remain concordant in most heart failure patients, supporting the ongoing use of JVP to estimate PCWP. Easily identifiable patient characteristics were associated with an increased RAP/PCWP ratio, and their presence should alert clinicians that PCWP may be overestimated by JVP assessment. A higher RAP/PCWP ratio was an adverse risk factor for post-cardiac transplant survival.
颈静脉压（JVP）用于评估心力衰竭患者的容量状态，因为右心房压（RAP）反映肺毛细血管楔压（PCWP）。在跨越 14 年的大型心力衰竭患者队列中，我们进一步研究了 RAP 与 PCWP 之间的关系，包括确定时间趋势，以优化通过 JVP 估计 PCWP。我们还试图确定 RAP 与 PCWP 关系是否会影响移植后的死亡率。
从 4079 名接受心脏移植前的患者中获得血流动力学数据。RAP 升高定义为≥10mmHg，PCWP 升高定义为≥22mmHg。当 RAP 和 PCWP 均升高或均不升高时，血流动力学“一致”。评估了 3 个时代（1993 年至 1997 年、1998 年至 2002 年、2003 年至 2007 年）中一致血流动力学的频率。根据 RAP+1/PCWP 的四分位数比较了基线特征。使用多变量模型评估心脏移植后 2 年死亡率与（RAP+1）/PCWP 的关系。
随着时间的推移，一致血流动力学的频率保持稳定（74%、72%、73%；p=0.4）。（RAP+1）/PCWP 逐渐升高与以下变量相关：女性；除缺血性或非缺血性以外的心肌病病因；先前的胸骨切开术；以及肌酐清除率降低（所有 p<0.01）。升高的（RAP+1）/PCWP 与移植后死亡率相关（相对风险 1.2，95%置信区间 1.02 至 1.37，p=0.02）。
在大多数心力衰竭患者中，RAP 和 PCWP 仍然一致，这支持继续使用 JVP 来估计 PCWP。易于识别的患者特征与 RAP/PCWP 比值增加相关，其存在应提醒临床医生，JVP 评估可能高估了 PCWP。较高的 RAP/PCWP 比值是心脏移植后生存的不利危险因素。
