Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
Chest. 2014 May;145(5):1064-1070. doi: 10.1378/chest.13-1510.
Reduced pulmonary arterial compliance (Ca) is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that pulmonary arterial Ca could be a predictor of outcome in patients with chronic heart failure (CHF).
We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right-sided heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end point was cardiovascular death; secondary end point was the composite of cardiovascular death, urgent heart transplantation, and appropriately detected and treated episode of ventricular fibrillation.
An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 s. In patients with pulmonary capillary wedge pressure (PCWP) < 15 mm Hg, the mean RC-time was 0.34 ± 0.14 s, and in patients with PCWP ≥ 15 mm Hg it was 0.28 ± 0.22 s. Eighty-seven patients died in a follow-up period of 50 ± 32 months. At receiver operating characteristic curve analysis, the optimal prognostic cutoff point of SV/PP was 2.15 mL/mm Hg. An elevated (> 2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high (P = .003) and in patients with normal pulmonary vascular resistance (P = .005).
Pulmonary arterial Ca is a strong prognostic indicator in patients with CHF with sLVD. Most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance.
肺血管顺应性（Ca）降低是特发性肺动脉高压预后不良的标志物。我们检验了这样一个假设，即肺血管 Ca 可能是慢性心力衰竭（CHF）患者预后的预测因子。
我们纳入了 306 例因收缩性左心室功能障碍（sLVD）导致 CHF 的患者，这些患者均接受了临床驱动的右侧心脏导管检查。通过每搏量与脉搏压的比值（SV/PP）测量肺血管 Ca。主要终点是心血管死亡；次要终点是心血管死亡、紧急心脏移植和适当检测和治疗的心室颤动发作的复合终点。
SV/PP 与肺血管阻力呈反比关系，平均阻力顺应性乘积（RC-time）为 0.30±0.2 s。在肺毛细血管楔压（PCWP）<15mmHg 的患者中，平均 RC-time 为 0.34±0.14s，而在 PCWP≥15mmHg 的患者中，平均 RC-time 为 0.28±0.22s。在 50±32 个月的随访期间，87 例患者死亡。在接受者操作特征曲线分析中，SV/PP 的最佳预后截断值为 2.15mL/mm Hg。与任何其他血流动力学变量相比，SV/PP 升高（>2.15）与生存的相关性更强；它与高（P=0.003）和正常肺血管阻力（P=0.005）患者的不良预后均相关。
在 sLVD 导致的 CHF 患者中，肺血管 Ca 是一个强有力的预后指标。最重要的是，其预后作用在肺血管阻力正常的患者中仍然保留。
