特发性肺动脉高压和艾森曼格综合征患者的左心室质量得以保留。
Left ventricular mass is preserved in patients with idiopathic pulmonary arterial hypertension and Eisenmenger's syndrome.
机构信息
Department of Cardiac and Vascular Diseases of the John Paul II Hospital in Krakow and the Jagiellonian University Medical School in Krakow, Poland.
Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria.
出版信息
Heart Lung Circ. 2014 May;23(5):454-61. doi: 10.1016/j.hlc.2013.12.002. Epub 2013 Dec 11.
BACKGROUND
Left ventricular (LV) atrophic remodelling was described for chronic thromboembolic pulmonary hypertension (PH) but not in other forms of PH. We aimed to assess LV morphometric changes in idiopathic pulmonary arterial hypertension (IPAH) and Eisenmenger's syndrome(ES).
METHODS
Fifteen patients with IPAH, 15 patients with ES and 15 healthy volunteers were included. Magnetic resonance was used to measure masses of LV, interventricular septum (IVS), LV free wall (LVFW), and LV end diastolic volume (LVEDV) indexed for body surface area.
RESULTS
Between patients with IPAH, ES and controls no differences in LVmassindex (54.4[45.2-63.3] vs 58.7[41.5-106.1] vs 52.8[46.5-59.3], p=0.50), IVSmassindex (21.6[18.2-21.9)] vs 27.4[18.0-32.9] vs 20.7[18.2-23.2], p=0.18), and LVFWmassindex ([32.4[27.1-40.0] vs 36.7[30.9-62.1] vs 32.5[26.9-36.1], p=0.29) were found. LVEDVindex was lower in IPAH patients than in controls and in ES patients (54.9[46.9-58.5] vs 75.2[62.4-88.9] vs 73.5[62.1-77.5], p<0.001). In IPAH LVEDV but not LV mass correlated with pulmonary vascular resistance (r=-0.56, p=0.03) and cardiac output (r=0.59, p=0.02).
CONCLUSIONS
LV mass is not reduced in patients with IPAH and with ES and is not affected by haemodynamic severity of PH. LVEDV is reduced in IPAH patients in proportion to reduced pulmonary flow but preserved in patients with ES, where reduced pulmonary flow to LV is compensated by right-to left shunt.
背景
左心室（LV）萎缩性重构已在慢性血栓栓塞性肺动脉高压（PH）中被描述，但在其他形式的 PH 中尚未发现。我们旨在评估特发性肺动脉高压（IPAH）和艾森曼格综合征（ES）患者的 LV 形态变化。
方法
纳入 15 例 IPAH 患者、15 例 ES 患者和 15 名健康志愿者。使用磁共振成像（MRI）测量 LV、室间隔（IVS）、LV 游离壁（LVFW）和 LV 舒张末期容积（LVEDV）的质量，并对体表面积进行指数化。
结果
在 IPAH、ES 和对照组患者之间，LVmassindex（54.4[45.2-63.3] vs 58.7[41.5-106.1] vs 52.8[46.5-59.3]，p=0.50）、IVSmassindex（21.6[18.2-21.9)] vs 27.4[18.0-32.9] vs 20.7[18.2-23.2]，p=0.18）和 LVFWmassindex（[32.4[27.1-40.0] vs 36.7[30.9-62.1] vs 32.5[26.9-36.1]，p=0.29）无显著差异。与对照组和 ES 组相比，IPAH 患者的 LVEDVindex 更低（54.9[46.9-58.5] vs 75.2[62.4-88.9] vs 73.5[62.1-77.5]，p<0.001）。在 IPAH 患者中，LVEDV 而非 LV 质量与肺血管阻力（r=-0.56，p=0.03）和心输出量（r=0.59，p=0.02）呈负相关。
结论
在 IPAH 和 ES 患者中，LV 质量并未降低，且不受 PH 血流动力学严重程度的影响。在 IPAH 患者中，LVEDV 与肺血流量成比例减少，但在 ES 患者中保留，在 ES 患者中，肺流向 LV 的减少通过右向左分流得到补偿。
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