在患有严重毛细血管前肺动脉高压的运动患者中，心率与平均肺动脉压之间存在强烈的线性关系。
Strong linear relationship between heart rate and mean pulmonary artery pressure in exercising patients with severe precapillary pulmonary hypertension.
机构信息
Physiology Department, Université Paris Sud-Faculté de Médecine-EA4533-APHP, Le Kremlin Bicêtre, France;
出版信息
Am J Physiol Heart Circ Physiol. 2013 Sep 1;305(5):H769-77. doi: 10.1152/ajpheart.00258.2013. Epub 2013 Jun 21.
The contribution of heart rate (HR) to pulmonary artery hemodynamics has been suggested in pulmonary hypertension (PH). Our high-fidelity pressure, retrospective study tested the hypothesis that HR explained the majority of mean pulmonary artery pressure (mPAP) and pulse pressure (PApp) variation in 12 severe precapillary PH patients who performed incremental-load cycling while in the supine position. Seven idiopathic pulmonary arterial hypertension patients and five chronic thromboembolic PH patients were studied. Four to five PAP-thermodilution cardiac output (CO) points (mean: 4.4) were obtained. At rest, mPAP was 57 ± 9 mmHg, PApp was 51 ± 11 mmHg, HR was 90 ± 12 beats/min, and stroke volume (SV) was 50 ± 22 ml. At peak exercise, mPAP was 76 ± 10 mmHg, PApp was 67 ± 11 mmHg, and HR was 123 ± 18 beats/min (i.e., 71 ± 10% of maximum HR, each P < 0.05), whereas SV was 51 ± 20 ml (P = not significant). The input resistance did not change (mPAP/CO = 14.1 ± 4.1 vs. 13.5 ± 4.4 mmHg·min·l(-1)). The relative increase in mPAP was related to the relative increase in HR (n = 12, r(2) = 0.74) but not in CO. mPAP was linearly related to CO in 8 of 12 patients (median r(2) = 0.83) and to HR in 12 of 12 patients (median r(2) = 0.985). The parsimony principle favored the latter fit. PApp was linearly related to mPAP in 12 of 12 patients (median r(2) = 0.985), HR in 10 of 12 patients (median r(2) = 0.97), CO in 7 of 12 patients (median r(2) = 0.87), and SV in 1 of 12 patients. A strong linear relationship between HR and mPAP was consistently documented in severe precapillary PH patients who performed supine exercise. The limited value of thermodilution CO to predict mPAP could be explained by unavoidable precision errors in CO measurements, unchanged/decreased SV on exercise, curvilinearity of the mPAP-CO relationship at high flow, or flow-independent additional mechanisms increasing mPAP on exercise.
心率（HR）对肺动脉血流动力学的贡献在肺动脉高压（PH）中已有提示。我们进行了这项高保真压力、回顾性研究，以检验以下假设：在 12 例严重毛细血管前 PH 患者进行仰卧位递增负荷自行车运动时，HR 可解释大部分平均肺动脉压（mPAP）和脉搏压（PApp）的变化。该研究纳入 7 例特发性肺动脉高压患者和 5 例慢性血栓栓塞性 PH 患者。共获得 4 至 5 个肺动脉热稀释心输出量（CO）点（平均：4.4 个）。在休息状态下，mPAP 为 57±9mmHg，PApp 为 51±11mmHg，HR 为 90±12 次/分，SV 为 50±22ml。在峰值运动时，mPAP 为 76±10mmHg，PApp 为 67±11mmHg，HR 为 123±18 次/分（即最大 HR 的 71±10%，每项 P＜0.05），而 SV 为 51±20ml（P=无显著差异）。输入阻力无变化（mPAP/CO=14.1±4.1 与 13.5±4.4mmHg·min·l(-1)）。mPAP 的相对增加与 HR 的相对增加相关（n=12，r(2)=0.74），但与 CO 无关。在 12 例患者中有 8 例（中位数 r(2)=0.83）mPAP 与 CO 呈线性相关，12 例患者中有 12 例（中位数 r(2)=0.985）mPAP 与 HR 呈线性相关。简约原则更倾向于后者。在 12 例患者中有 12 例（中位数 r(2)=0.985）PApp 与 mPAP 呈线性相关，12 例患者中有 10 例（中位数 r(2)=0.97）PApp 与 HR 呈线性相关，12 例患者中有 7 例（中位数 r(2)=0.87）PApp 与 CO 呈线性相关，12 例患者中有 1 例（中位数 r(2)=0.1）PApp 与 SV 呈线性相关。在进行仰卧位运动的严重毛细血管前 PH 患者中，始终记录到 HR 与 mPAP 之间存在较强的线性关系。热稀释 CO 预测 mPAP 的价值有限，这可能是由于 CO 测量的不可避免的精度误差、运动时 SV 不变或减少、高流量时 mPAP-CO 关系的曲线性或运动时增加 mPAP 的其他独立于流量的机制所致。
Zotero 插件