Chow Vincent, Ng Austin C C, Seccombe Leigh, Chung Tommy, Thomas Liza, Celermajer David S, Peters Matthew, Kritharides Leonard
ANZAC Research Institute, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital and The University of Sydney, Sydney, Australia.
Department of Cardiology, Concord Repatriation General Hospital and The University of Sydney, Sydney, Australia.
Respir Med. 2014 Oct;108(10):1556-65. doi: 10.1016/j.rmed.2014.08.002. Epub 2014 Aug 13.
The functional capacity of long-term survivors of submassive pulmonary embolism (PE) is unreported. A six-minute walk distance (6MWD) <350 m and reduced heart rate recovery (HRR) indicate adverse prognosis in various chronic diseases.
Long-term survivors of acute PE (January 2000-June 2005) were invited to undergo prospectively planned six-minute walk test (6MWT), transthoracic echocardiogram (TTE), clinical and biochemical evaluation with cardiac biomarkers. HRR was calculated as the difference between heart rate at 6-min during and at 1-min post 6MWT.
120 patients (52 males; mean age [±standard deviation] - 65 ± 14 years) were identified 7.7 ± 1.4 years after PE. 6MWD was significantly lower than that predicted after adjustment for age, sex, and height (448 ± 114 m vs 475 ± 89 m, p = 0.005), and 16% (17/104) had 6MWD <350 m. Among patients with no baseline comorbidities at follow-up (Charlson comorbidity index = 0), 8% (4/52) had 6MWD <350 m. Resting TTE identified 29% of patients had raised right ventricular (RV) pulmonary pressure (pulmonary arterial systolic pressure [PASP] >36 mmHg) and 13% had impaired RV function. Patients with 6MWD <85% predicted had significantly greater impairment of RV longitudinal function (p < 0.001), higher PASP (p < 0.001) and pulmonary vascular resistance (p < 0.001), elevated NT-proBNP (p = 0.03) and high-sensitivity troponin-T (HsTropT, p = 0.03), but similar left ventricular systolic and diastolic function, to those with normal 6MWT.
Apparently well, long-term survivors of PE demonstrate impaired exercise capacity, heart rate recovery, mild pulmonary hypertension, raised PVR and right ventricular dysfunction associated with elevated NT-proBNP and HsTropT.
亚大面积肺栓塞（PE）长期存活者的功能能力尚未见报道。六分钟步行距离（6MWD）<350米和心率恢复（HRR）降低表明各种慢性疾病预后不良。
邀请急性PE（2000年1月至2005年6月）的长期存活者接受前瞻性计划的六分钟步行试验（6MWT）、经胸超声心动图（TTE）以及使用心脏生物标志物进行临床和生化评估。HRR计算为6MWT期间6分钟时与6MWT后1分钟时心率的差值。
在PE发生7.7±1.4年后，共纳入120例患者（52例男性；平均年龄[±标准差] - 65±14岁）。调整年龄、性别和身高后，6MWD显著低于预测值（448±114米对475±89米，p = 0.005），16%（17/104）的患者6MWD<350米。在随访时无基线合并症（Charlson合并症指数 = 0）的患者中，8%（4/52）的患者6MWD<350米。静息TTE检查发现29%的患者右心室（RV）肺动脉压力升高（肺动脉收缩压[PASP]>36 mmHg），13%的患者RV功能受损。6MWD<预测值85%的患者RV纵向功能损害显著更严重（p<0.001），PASP更高（p<0.001）和肺血管阻力更高（p<0.001），NT-proBNP升高（p = 0.03）和高敏肌钙蛋白T（HsTropT, p = 0.03），但与6MWT正常的患者相比，左心室收缩和舒张功能相似。
PE的长期存活者表面上情况良好，但表现出运动能力受损、心率恢复不良、轻度肺动脉高压、肺血管阻力升高以及与NT-proBNP和HsTropT升高相关的右心室功能障碍。
