Sato Takahiro, Tsujino Ichizo, Ohira Hiroshi, Oyama-Manabe Noriko, Ito Yoichi M, Yamada Asuka, Ikeda Daisuke, Watanabe Taku, Nishimura Masaharu
First Department of Medicine.
First Department of Medicine.
J Heart Lung Transplant. 2015 Mar;34(3):414-23. doi: 10.1016/j.healun.2015.01.984. Epub 2015 Feb 7.
Symptoms and signs and indices of right heart function are predictors of clinical outcomes in patients with pulmonary hypertension (PH). However, the significance of right atrial (RA) indices has not been sufficiently investigated. We investigated whether RA parameters predict outcomes in patients with pre-capillary PH.
Study subjects were 68 patients with pre-capillary PH. RA size and function (systolic, reservoir, and conduit functions) were evaluated by cardiac magnetic resonance imaging.
During the mean follow-up period of 24 months, 16 of 68 patients experienced clinical worsening (CW), defined as hospitalization because of right heart failure, lung transplantation, or PH-related death. Kaplan-Meier and log-rank test showed that World Health Organization functional class, pericardial effusion, increased brain natriuretic peptide concentration, reduced right ventricular ejection fraction (RVEF), increased minimum RA volume index, and decreased RA reservoir volume were associated with CW-free survival. The combination of RVEF and RA reservoir function was a better predictor of CW-free survival. In univariate Cox hazard proportional analysis, CW was associated with the RA reservoir volume index (hazard ratio [HR] = 0.80). In multivariate analysis, CW was associated with World Health Organization functional class (HR = 4.3), RA minimum volume index (HR = 1.07), and RA reservoir volume index (HR = 0.73).
RA volume and reservoir function and their combined use with RVEF are novel predictors of CW in patients with pre-capillary PH.
症状、体征及右心功能指标是肺动脉高压（PH）患者临床预后的预测因素。然而，右心房（RA）指标的意义尚未得到充分研究。我们研究了RA参数是否可预测毛细血管前性PH患者的预后。
研究对象为68例毛细血管前性PH患者。通过心脏磁共振成像评估RA大小和功能（收缩功能、储存功能及管道功能）。
在平均24个月的随访期内，68例患者中有16例出现临床恶化（CW），定义为因右心衰竭、肺移植或PH相关死亡而住院。Kaplan-Meier法和对数秩检验显示，世界卫生组织功能分级、心包积液、脑钠肽浓度升高、右心室射血分数（RVEF）降低、最小RA容积指数增加及RA储存容积减少与无CW生存相关。RVEF和RA储存功能的联合是无CW生存的更好预测指标。在单因素Cox风险比例分析中，CW与RA储存容积指数相关（风险比[HR]=0.80）。在多因素分析中，CW与世界卫生组织功能分级（HR=4.3）、RA最小容积指数（HR=1.07）及RA储存容积指数（HR=0.73）相关。
RA容积和储存功能及其与RVEF的联合应用是毛细血管前性PH患者CW的新型预测指标。
