CHU Nancy, Pôle des spécialités médicales/Département de Pneumologie, Vandoeuvre-lès-Nancy, France Université de Lorraine, INGRES, EA 7298, Vandoeuvre-lès-Nancy, France
AP-HP, CHU de Bicêtre, Service de Pneumologie, Centre de Référence de l'hypertension pulmonaire sévère, DHU TORINO, Le Kremlin-Bicêtre, France Université Paris-Sud, INSERM U999, Le Kremlin-Bicêtre, France.
Eur Respir J. 2014 Sep;44(3):704-13. doi: 10.1183/09031936.00153613. Epub 2014 May 15.
The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise. 55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3-5 months into the PAH treatment in 20 patients. Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r=0.414 and r=0.481, respectively; p<0.01). Change in 6-min walk distance from baseline to 3-5 months under PAH treatment was highly correlated with change in exercise cardiac index (r=0.746, p<0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37-0.86) and 0.14 (95% CI 0.05-0.43), respectively). Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies.
本研究旨在探讨运动期间右心导管检查变量对预后的预测价值。55 例特发性、家族性或厌食相关肺动脉高压（PAH）患者在 PAH 治疗前进行了右心导管检查，包括静息和运动状态以及 6 分钟步行试验。患者在接下来的 2 周内根据建议进行治疗。20 例患者在 PAH 治疗 3-5 个月时重复进行右心导管检查。随着纽约心脏协会（NYHA）功能分级的增加，运动心指数逐渐下降，而静息心指数在 NYHA 各组之间无显著差异。基线 6 分钟步行距离与运动和静息至运动心指数的变化显著相关（r=0.414 和 r=0.481，分别；p<0.01）。PAH 治疗 3-5 个月时的 6 分钟步行距离变化与运动心指数的变化高度相关（r=0.746，p<0.001）。与生存相关的最重要的基线协变量是从静息到运动时收缩压肺动脉压的变化和运动心指数（危险比 0.56（95%CI 0.37-0.86）和 0.14（95%CI 0.05-0.43））。运动期间肺血流动力学的变化是评估疾病严重程度的重要工具，可能有助于制定最佳的靶向治疗策略。
