Hirashiki Akihiro, Kondo Takahisa, Okumura Takahiro, Kamimura Yoshihiro, Nakano Yoshihisa, Fukaya Kenji, Sawamura Akinori, Morimoto Ryota, Adachi Shiro, Takeshita Kyosuke, Murohara Toyoaki
Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Noninvasive Electrocardiol. 2016 May;21(3):263-71. doi: 10.1111/anec.12308. Epub 2016 Feb 1.
Recently, it has become increasingly recognized that pulmonary hypertension (PH) is a particularly threatening result of left-sided heart disease. However, there have been few investigations of the impact of cardiopulmonary exercise testing (CPX) variables on PH in dilated cardiomyopathy (DCM). We evaluated the usefulness of crucial CPX variables for detecting elevated pulmonary arterial pressure (PAP) in patients with DCM.
Ninety subjects with DCM underwent cardiac catheterization and CPX at our hospital. Receiver operator characteristic (ROC) analysis was performed to assess the ability of CPX variables to distinguish between the presence and absence of PH.
Overall mean values were: mean PAP (mPAP), 18.0 ± 9.6 mmHg; plasma brain natriuretic peptide, 233 ± 295 pg/mL; and left ventricular ejection fraction, 30.2 ± 11.0%. Patients were allocated to one of two groups on the basis of mean PAP, namely DCM without PH [mean PAP (mPAP) <25 mmHg; n = 75] and DCM with PH (mPAP ≥25 mmHg; n = 15). A cutoff achieved percentage of predicted peak VO2 (%PPeak VO2 ) of 52.5% was the best predictor of an mPAP ≥25 mmHg in the ROC analysis (area under curve: 0.911). In the multivariate analysis, %PPeak VO2 was the only significant independent predictor of PH (Wald 6.52, odds ratio 0.892, 95% CI 0.818-0.974; P = 0.011).
%PPeak VO2 was strongly associated with the presence of PH in patients with DCM. Taken together, these findings indicate that CPX variables could be important for diagnosing PH in patients with DCM.
最近，越来越多的人认识到肺动脉高压（PH）是左心疾病的一个特别危险的后果。然而，关于心肺运动试验（CPX）变量对扩张型心肌病（DCM）患者PH的影响的研究很少。我们评估了关键CPX变量在检测DCM患者肺动脉压（PAP）升高方面的有用性。
90例DCM患者在我院接受了心导管检查和CPX。进行了受试者工作特征（ROC）分析，以评估CPX变量区分有无PH的能力。
总体平均值为：平均PAP（mPAP），18.0±9.6 mmHg；血浆脑钠肽，233±295 pg/mL；左心室射血分数，30.2±11.0%。根据平均PAP将患者分为两组，即无PH的DCM组[平均PAP（mPAP）<25 mmHg；n = 75]和有PH的DCM组（mPAP≥25 mmHg；n = 15）。在ROC分析中，预测峰值VO2百分比（%PPeak VO2）的截断值为52.5%是mPAP≥25 mmHg的最佳预测指标（曲线下面积：0.911）。在多变量分析中，%PPeak VO2是PH的唯一显著独立预测指标（Wald 6.52，优势比0.892，95% CI 0.818 - 0.974；P = 0.011）。
%PPeak VO2与DCM患者PH的存在密切相关。综上所述，这些发现表明CPX变量对于诊断DCM患者的PH可能很重要。
