慢性血栓栓塞性肺动脉阻塞中的右心室功能障碍：一项使用导管法的压力-容积研究
Right ventricular dysfunction in chronic thromboembolic obstruction of the pulmonary artery: a pressure-volume study using the conductance catheter.
作者信息
McCabe Colm, White Paul A, Hoole Stephen P, Axell Richard G, Priest Andrew N, Gopalan Deepa, Taboada Dolores, MacKenzie Ross Robert, Morrell Nicholas W, Shapiro Leonard M, Pepke-Zaba Joanna
机构信息
Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom;
出版信息
J Appl Physiol (1985). 2014 Feb 15;116(4):355-63. doi: 10.1152/japplphysiol.01123.2013. Epub 2013 Dec 19.
Pressure-volume loops describe dynamic ventricular performance, relevant to patients with and at risk of pulmonary hypertension. We used conductance catheter-derived pressure-volume loops to measure right ventricular (RV) mechanics in patients with chronic thromboembolic pulmonary arterial obstruction at different stages of pathological adaptation. Resting conductance catheterization was performed in 24 patients: 10 with chronic thromboembolic pulmonary hypertension (CTEPH), 7 with chronic thromboembolic disease without pulmonary hypertension (CTED), and 7 controls. To assess the validity of conductance measurements, RV volumes were compared in a subset of 8 patients with contemporaneous cardiac magnetic resonance (CMR). Control, CTED, and CTEPH groups showed different pressure-volume loop morphology, most notable during systolic ejection. Prolonged diastolic relaxation was seen in patients with CTED and CTEPH [tau = 56.2 ± 6.7 (controls) vs. 69.7 ± 10.0 (CTED) vs. 67.9 ± 6.2 ms (CTEPH), P = 0.02]. Control and CTED groups had lower afterload (Ea) and contractility (Ees) compared with the CTEPH group (Ea = 0.30 ± 0.10 vs. 0.52 ± 0.24 vs. 1.92 ± 0.70 mmHg/ml, respectively, P < 0.001) (Ees = 0.44 ± 0.20 vs. 0.59 ± 0.15 vs. 1.13 ± 0.43 mmHg/ml, P < 0.01) with more efficient ventriculoarterial coupling (Ees/Ea = 1.46 ± 0.30 vs. 1.27 ± 0.36 vs. 0.60 ± 0.18, respectively, P < 0.001). Stroke volume assessed by CMR and conductance showed closest agreement (mean bias +9 ml, 95% CI -1 to +19 ml) compared with end-diastolic volume (+48 ml, -16 to 111 ml) and end-systolic volume (+37 ml, -21 to 94 ml). RV conductance catheterization detects novel alteration in pressure-volume loop morphology and delayed RV relaxation in CTED, which distinguish this group from controls. The observed agreement in stroke volume assessed by CMR and conductance suggests RV mechanics are usefully measured by conductance catheter in chronic thromboembolic obstruction.
压力-容积环描述了动态心室功能，这与患有肺动脉高压以及有肺动脉高压风险的患者相关。我们使用基于电导导管的压力-容积环来测量处于不同病理适应阶段的慢性血栓栓塞性肺动脉阻塞患者的右心室（RV）力学。对24例患者进行了静息电导导管检查：10例患有慢性血栓栓塞性肺动脉高压（CTEPH），7例患有无肺动脉高压的慢性血栓栓塞性疾病（CTED），7例为对照组。为了评估电导测量的有效性，在8例同时进行心脏磁共振成像（CMR）的患者亚组中比较了右心室容积。对照组、CTED组和CTEPH组显示出不同的压力-容积环形态，在收缩期射血期间最为明显。在CTED和CTEPH患者中观察到舒张期松弛延长[时间常数（tau）= 56.2±6.7（对照组） vs. 69.7±10.0（CTED） vs. 67.9±6.2毫秒（CTEPH），P = 0.02]。与CTEPH组相比，对照组和CTED组的后负荷（Ea）和收缩力（Ees）较低（Ea分别为0.30±0.10 vs. 0.52±0.24 vs. 1.92±0.70 mmHg/ml，P < 0.001）（Ees分别为0.44±0.20 vs. 0.59±0.15 vs. 1.13±0.43 mmHg/ml，P < 0.01），心室动脉耦合更有效（Ees/Ea分别为1.46±0.30 vs. 1.27±0.36 vs. 0.60±0.18，P < 0.001）。与舒张末期容积（+48 ml，-16至111 ml）和收缩末期容积（+37 ml，-21至94 ml）相比，通过CMR和电导评估的每搏输出量显示出最接近的一致性（平均偏差+9 ml，95%可信区间-1至+19 ml）。右心室电导导管检查检测到CTED患者压力-容积环形态的新变化以及右心室舒张延迟，这将该组与对照组区分开来。通过CMR和电导评估的每搏输出量之间观察到的一致性表明，在慢性血栓栓塞性阻塞中，右心室力学可以通过电导导管有效地测量。
Zotero 插件