Masri S Carolina, Tedford Ryan J, Colvin Monica M, Leary Peter J, Cogswell Rebecca
From the *Division of Cardiology, University of Washington, Seattle, Washington; †Division of Cardiology, John Hopkins Medical Institutions, Baltimore, Maryland; ‡Division of Cardiology, University of Michigan, Ann Arbor, Michigan; §Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington; and ¶Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
ASAIO J. 2017 Mar/Apr;63(2):139-143. doi: 10.1097/MAT.0000000000000467.
Pulmonary artery compliance (PAC) contributes to right ventricular (RV) afterload, is decreased in the setting of increased left ventricular (LV) filling pressures, and may be an important component of World Health Organization (WHO) group II pulmonary hypertension (PH). Left ventricular assist device (LVAD) implantation can rapidly change LV filling, but its relationship with PAC is unknown. Right heart catheterization was performed preoperatively, postoperatively (between 48 and 72 hours), and >30 days post-LVAD implantation in a cohort of 64 patients with end-stage systolic heart failure. Within 72 hours, LVAD implantation was associated with an increase in PAC (2.0-3.7 ml/mm Hg, p < 0.0001), a decrease in pulmonary vascular resistance (3.5-1.7 Wood units, p < 0.0001). Pulmonary arterial compliance did not increase further at the >30 post-LVAD time point (3.7 ± 1.7 to 3.6 ± 0.44 ml/mm Hg, p = 0.44). Pulmonary artery compliance improves rapidly after LVAD implantation. This suggests that more permanent changes in the pulmonary vascular bed may not be responsible for the abnormal PAC observed in WHO group II PH.
肺动脉顺应性（PAC）影响右心室（RV）后负荷，在左心室（LV）充盈压升高时降低，可能是世界卫生组织（WHO）II组肺动脉高压（PH）的重要组成部分。左心室辅助装置（LVAD）植入可迅速改变LV充盈，但它与PAC的关系尚不清楚。对64例终末期收缩性心力衰竭患者进行术前、术后（48至72小时之间）及LVAD植入后>30天的右心导管检查。在72小时内，LVAD植入与PAC增加（2.0 - 3.7 ml/mm Hg，p < 0.0001）、肺血管阻力降低（3.5 - 1.7伍德单位，p < 0.0001）相关。在LVAD植入后>30天时间点，肺动脉顺应性未进一步增加（3.7 ± 1.7至3.6 ± 0.44 ml/mm Hg，p = 0.44）。LVAD植入后肺动脉顺应性迅速改善。这表明肺血管床更持久的变化可能与WHO II组PH中观察到的异常PAC无关。
