Richter Manuel Jonas, Sommer Natascha, Gall Henning, Voswinckel Robert, Seeger Werner, Mayer Eckhard, Wiedenroth Christoph B, Rieth Andreas, Grimminger Friedrich, Guth Stefan, Ghofrani Hossein A
Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.
Respiration. 2015;90(1):63-73. doi: 10.1159/000398815. Epub 2015 Jun 3.
Pulmonary endarterectomy (PEA) is the treatment of choice in surgically accessible chronic thromboembolic pulmonary hypertension (CTEPH). An important predictor of outcome is postsurgical residual pulmonary hypertension.
We aimed to use the hemodynamic response during exercise before PEA as a measurement for the hemodynamic outcome 1 year after PEA.
Between January 2011 and December 2013, 299 patients underwent PEA in our center. A total of 16 patients who were assessed by means of invasive hemodynamic measurements during exercise both at baseline and 1 year after PEA were retrospectively analyzed.
Pre-PEA mean pulmonary arterial pressure (mPAP) increased during exercise from 35.8 ± 7.6 to 53.8 ± 5.1 mm Hg, diastolic pulmonary arterial pressure (dPAP) from 21.5 ± 5.6 to 30.3 ± 9.6 mm Hg, cardiac output (CO) from 4.4 ± 0.8 to 6.5 ± 1.9 l/min and diastolic pulmonary gradient (DPG) from 14.6 ± 4.9 to 20.7 ± 12.7 mm Hg. Post-PEA mPAP increased from 23.7 ± 6.6 at rest to 43.2 ± 7.1 mm Hg, while CO increased to a higher extent from 5.1 ± 0.9 to 8.4 ± 1.9 l/min. There were significant correlations between pre-PEA DPG/CO and dPAP/CO slopes with the pulmonary vascular resistance (Spearman r = 0.578, p = 0.019, and r = 0.547, p = 0.028) and mPAP at rest after PEA (Spearman r = 0.581, p = 0.018, and r = 0.546, p = 0.028).
In CTEPH, the presurgical dynamic DPG/CO and dPAP/CO slopes during submaximal exercise are associated with the hemodynamic outcome 1 year after PEA.
对于手术可及的慢性血栓栓塞性肺动脉高压（CTEPH），肺动脉内膜剥脱术（PEA）是首选治疗方法。术后残余肺动脉高压是预后的一个重要预测指标。
我们旨在将PEA术前运动期间的血流动力学反应作为PEA术后1年血流动力学结果的一项衡量指标。
2011年1月至2013年12月期间，299例患者在我们中心接受了PEA手术。对其中16例在基线及PEA术后1年通过运动期间有创血流动力学测量进行评估的患者进行回顾性分析。
PEA术前运动期间平均肺动脉压（mPAP）从35.8±7.6mmHg升高至53.8±5.1mmHg，舒张期肺动脉压（dPAP）从21.5±5.6mmHg升高至30.3±9.6mmHg，心输出量（CO）从4.4±0.8L/min升高至6.5±1.9L/min，舒张期肺压差（DPG）从14.6±4.9mmHg升高至20.7±12.7mmHg。PEA术后，mPAP从静息时的23.7±6.6mmHg升高至43.2±7.1mmHg，而CO升高幅度更大，从5.1±0.9L/min升高至8.4±1.9L/min。PEA术前DPG/CO和dPAP/CO斜率与肺血管阻力（Spearman相关系数r = 0.578，p = 0.019，以及r = 0.547，p = 0.028）和PEA术后静息时的mPAP（Spearman相关系数r = 0.581，p = 0.018，以及r = 0.546，p = 0.028）之间存在显著相关性。
在CTEPH中，次极量运动期间术前动态DPG/CO和dPAP/CO斜率与PEA术后1年的血流动力学结果相关。
