The Heart Centre, Chaim Sheba Medical Centre, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Centre, Tel Hashomer, Israel.
Eur J Heart Fail. 2015 Feb;17(2):151-8. doi: 10.1002/ejhf.198. Epub 2014 Dec 8.
Heart failure with preserved ejection fraction can lead to pulmonary hypertension. The aim of the present study was to evaluate the role of exercise during right heart catheterization in the unmasking of diastolic dysfunction.
Between 2004 and 2012, 200 symptomatic patients with exertional dyspnoea, preserved left ventricular systolic function and suspected pulmonary hypertension, underwent right heart catheterization. Included in the study were 63 patients with resting pulmonary arterial wedge pressure (PAWP) ≤15 mmHg. Patients were divided to three tertiles based on their peak exercise PAWP. Mean age was 60 ± 20 years and 29% were males. Mean pulmonary arterial pressure was 31 ± 14 mmHg at rest and 42 ± 18 mmHg upon exercise. Mean change in PAWP between rest and exercise was 0.0 ± 4.3, 4.6 ± 2.4, and 16.6 ± 7.1 mmHg in the lower, middle, and upper tertiles, respectively (P < 0.001). Higher exercise PAWP tertiles were associated with reduced pulmonary vascular resistance (8.3 ± 6.7, 2.9 ± 2.7, and 5.8 ± 4.6 Woods units, respectively; P = 0.004). A multivariate linear regression model demonstrated that each 5 kg/m(2) increase in body mass index was associated with 2.5 ± 1.0 mmHg increase in exercise PAWP (P = 0.017). A multivariate binary logistic model showed that subjects with borderline PAWP at rest (12-15 mmHg) were 4.5 times more likely to be in the upper tertile of exercise PAWP (P = 0.011).
In symptomatic patients with pulmonary hypertension, preserved left ventricular ejection fraction and PAWP ≤15 mmHg, exercise during right heart catheterization may unmask diastolic dysfunction. This is especially true for obese patients and patients with borderline resting PAWP.
射血分数保留的心力衰竭可导致肺动脉高压。本研究旨在评估右心导管检查过程中运动对舒张功能障碍的揭示作用。
2004 年至 2012 年间，200 例因运动性呼吸困难、左心室收缩功能保留和疑似肺动脉高压而就诊的有症状患者接受了右心导管检查。研究纳入了静息肺动脉楔压（PAWP）≤15mmHg 的 63 例患者。根据患者运动时的峰值 PAWP，将患者分为三组。平均年龄为 60±20 岁，29%为男性。静息时平均肺动脉压为 31±14mmHg，运动时为 42±18mmHg。静息和运动时 PAWP 的平均变化分别为 0.0±4.3mmHg、4.6±2.4mmHg 和 16.6±7.1mmHg（P<0.001）。运动时 PAWP 较高的 tertile 与较低的肺血管阻力相关（分别为 8.3±6.7、2.9±2.7 和 5.8±4.6 Woods 单位；P=0.004）。多元线性回归模型表明，体重指数每增加 5kg/m²，运动时 PAWP 增加 2.5±1.0mmHg（P=0.017）。多元二项逻辑回归模型显示，静息时 PAWP 处于边界值（12-15mmHg）的患者，其运动时 PAWP 处于较高 tertile 的可能性是前者的 4.5 倍（P=0.011）。
在肺动脉高压、左心室射血分数保留和静息时 PAWP≤15mmHg 的有症状患者中，右心导管检查过程中的运动可能揭示舒张功能障碍。对于肥胖患者和静息时 PAWP 处于边界值的患者尤其如此。
