Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
J Am Soc Echocardiogr. 2012 Mar;25(3):274-9. doi: 10.1016/j.echo.2011.11.007. Epub 2011 Dec 3.
Acute pulmonary vasodilator testing is important for patients with pulmonary arterial hypertension, but little is known about the predictors of response to such testing.
Forty-eight patients (mean age, 41.3 ± 11.6 years; 91.7% women) with pulmonary arterial hypertension associated with connective tissue diseases who underwent right-heart catheterization and acute pulmonary vasodilator testing were prospectively recruited. Echocardiography was performed before and immediately after testing.
There were 14 responders (29.2%) to acute pulmonary vasodilator testing. Responders had lower pulmonary vascular resistance, higher peak systolic velocity of the lateral tricuspid valve annulus (right ventricular [RV] S') and tricuspid annular plane systolic excursion, and smaller RV end-diastolic area. After vasodilator testing, mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly in both groups, cardiac index increased significantly in responders, and RV function improved significantly in nonresponders. Receiver operating characteristic curve analysis identified an optimal cutoff value for RV S' of ≥10.5 cm/sec to predict response, with sensitivity of 71% and specificity of 71%. There were more responders among patients with RV S' ≥ 10.5 cm/sec (45.5% vs 15.4%, P = .02). On multivariate logistic regression analysis, RV S' ≥ 10.5cm/sec emerged as an independent predictor of response (odds ratio, 4.58; 95% confidence interval, 1.18-17.79; P = .02).
Right-heart function is better in responders to acute pulmonary vasodilator testing than in nonresponders among patients with pulmonary arterial hypertension associated with connective tissue diseases, and pulmonary vasodilators may improve RV function in nonresponders and cardiac index in responders. RV S' is a simple and clinically useful tool for predicting the results of pulmonary vasodilator testing.
急性肺血管扩张剂测试对于肺动脉高压患者很重要，但对于预测此类测试反应的指标知之甚少。
前瞻性招募了 48 例（平均年龄 41.3±11.6 岁；91.7%为女性）因结缔组织疾病相关肺动脉高压而行右心导管检查和急性肺血管扩张剂测试的患者。在测试前后进行了超声心动图检查。
14 例（29.2%）对急性肺血管扩张剂测试有反应。与无反应者相比，反应者的肺血管阻力较低，三尖瓣环侧壁收缩期峰值速度（右心室[S']）和三尖瓣环平面收缩期位移较高，右心室舒张末期面积较小。在血管扩张剂测试后，两组的平均肺动脉压和肺血管阻力均显著下降，反应者的心输出量显著增加，无反应者的右心室功能显著改善。受试者工作特征曲线分析确定了 RV S'≥10.5cm/sec 的最佳截断值以预测反应，其敏感性为 71%，特异性为 71%。在 RV S'≥10.5cm/sec 的患者中，反应者更多（45.5% vs 15.4%，P=0.02）。多变量逻辑回归分析显示，RV S'≥10.5cm/sec 是对急性肺血管扩张剂测试有反应的独立预测因素（比值比，4.58；95%置信区间，1.18-17.79；P=0.02）。
在与结缔组织疾病相关的肺动脉高压患者中，对急性肺血管扩张剂测试有反应者的右心功能优于无反应者，而肺血管扩张剂可能改善无反应者的右心室功能和反应者的心输出量。RV S'是预测肺血管扩张剂测试结果的一种简单且具有临床意义的工具。
