接受肠外前列环素治疗的肺动脉高压患者超声心动图变化的预后价值
Prognostic value of echocardiographic changes in patients with pulmonary arterial hypertension receiving parenteral prostacyclin therapy.
作者信息
Tonelli Adriano R, Conci Diego, Tamarappoo Balaji K, Newman Jennie, Dweik Raed A
机构信息
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
J Am Soc Echocardiogr. 2014 Jul;27(7):733-741.e2. doi: 10.1016/j.echo.2014.03.012. Epub 2014 Apr 26.
BACKGROUND
It is unknown whether the echocardiographic changes observed after treatment of patients with pulmonary arterial hypertension have prognostic value.
METHODS
Subjects with pulmonary arterial hypertension, confirmed by right heart catheterization, who underwent Doppler echocardiography before (baseline) and after 1 year of treatment (follow-up) with parenteral prostacyclin analogues were retrospectively identified. Echocardiographic parameters were measured offline by two investigators.
RESULTS
A total of 48 patients were included (mean age, 45 ± 14 years; 83% women). Compared with baseline, follow-up echocardiography showed reductions in right atrial area (mean percentage change, 12 ± 25%; P < .001), right ventricular (RV) basal and middle cavity dimensions (mean percentage change, 8.5 ± 14% [P < .001] and 6.8 ± 17% [P = .005], respectively), and peak tricuspid regurgitant velocity (mean percentage change, 10 ± 14%; P < .001). Tricuspid annular plane systolic excursion (mean percentage change, 36 ± 43%; P < .001) and RV outflow tract time-velocity integral (mean percentage change, 48 ± 66%; P < .001) increased. During a median follow-up period of 52.5 months (interquartile range, 20.5-80 months), 18 patients (37.5%) died, mostly (n = 15 [83%]) from progression of pulmonary arterial hypertension. The changes in RV end-diastolic area (hazard ratio [HR per 10% decrease, 0.73; 95% confidence interval [CI], 0.57-0.93), tricuspid valve regurgitation velocity (HR per 10 cm/sec decrease, 0.58; 95% CI, 0.37-0.89), RV outflow tract velocity-time integral (HR per 10% increase, 0.90; 95% CI, 0.83-0.98), and subjective RV function (HR per 1 unit of improvement [e.g., from moderate to mild], 0.55; 95% CI, 0.31-0.96) were associated with overall mortality.
CONCLUSIONS
Echocardiographic parameters that estimate RV systolic pressure and assess RV morphology and function improve after 1 year of prostacyclin analogue treatment, and the degree of change has prognostic implications.
背景
肺动脉高压患者治疗后观察到的超声心动图变化是否具有预后价值尚不清楚。
方法
回顾性纳入经右心导管检查确诊为肺动脉高压的患者，这些患者在接受肠外前列环素类似物治疗前（基线）和治疗1年后（随访）接受了多普勒超声心动图检查。两名研究人员离线测量超声心动图参数。
结果
共纳入48例患者（平均年龄45±14岁；83%为女性）。与基线相比，随访超声心动图显示右心房面积减小（平均百分比变化为12±25%；P<.001），右心室（RV）基底和中间腔尺寸减小（平均百分比变化分别为8.5±14%[P<.001]和6.8±17%[P=.005]），以及三尖瓣反流峰值速度减小（平均百分比变化为10±14%；P<.001）。三尖瓣环平面收缩期位移（平均百分比变化为36±43%；P<.001）和RV流出道时间-速度积分（平均百分比变化为48±66%；P<.001）增加。在中位随访期52.5个月（四分位间距为20.5 - 80个月）内，18例患者（37.5%）死亡，大多数（n = 15[83%]）死于肺动脉高压进展。RV舒张末期面积的变化（每降低10%的风险比[HR]为0.73；95%置信区间[CI]为0.57 - 0.93）、三尖瓣反流速度（每降低10 cm/秒的HR为0.58；95% CI为0.37 - 0.89）、RV流出道速度-时间积分（每增加10%的HR为0.90；95% CI为0.83 - 0.98）以及主观RV功能（每改善1个单位[例如，从中度到轻度]的HR为0.55；95% CI为0.31 - 0.96）与总死亡率相关。
结论
估计RV收缩压并评估RV形态和功能的超声心动图参数在接受前列环素类似物治疗1年后有所改善，且变化程度具有预后意义。
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