Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium; Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy.
J Heart Lung Transplant. 2017 Jul;36(7):754-762. doi: 10.1016/j.healun.2016.12.011. Epub 2016 Dec 23.
Excessive exercise-induced hyperventilation and high prevalence of exercise oscillatory breathing (EOB) are present in patients with post-capillary pulmonary hypertension (PH) complicating left heart disease (LHD). Patients with pre-capillary PH have even higher hyperventilation but no EOB. We sought to determine the impact of a pre-capillary component of PH on ventilatory response to exercise in patients with PH and left heart disease.
We retrospectively compared patients with idiopathic or heritable pulmonary arterial hypertension (PAH, n = 29), isolated post-capillary PH (IpcPH, n = 29), and combined post- and pre-capillary PH (CpcPH, n = 12). Diastolic pressure gradient (DPG = diastolic pulmonary artery pressure - pulmonary wedge pressure) was used to distinguish IpcPH (DPG <7 mm Hg) from CpcPH (DPG ≥7 mm Hg).
Pulmonary vascular resistance (PVR) was higher in PAH, intermediate in CpcPH, and low in IpcPH. All patients with CpcPH but 1 had PVR >3 Wood unit. Exercise-induced hyperventilation (high minute ventilation over carbon dioxide production, low end-tidal carbon dioxide) was marked in PAH, intermediate in CpcPH, and low in IpcPH (p < 0.001) and correlated with DPG and PVR. Prevalence of EOB decreased from IpcPH to CpcPH to PAH (p < 0.001).
Patients with CpcPH may have worse hemodynamics than patients with IpcPH and distinct alterations of ventilatory control, consistent with more exercise-induced hyperventilation and less EOB. This might be explained at least in part by the presence and extent of pulmonary vascular disease.
在左心疾病（LHD）合并毛细血管后肺动脉高压（PH）的患者中，过度运动引起的过度通气和运动性呼吸振荡（EOB）的高发生率很常见。肺前毛细血管 PH 的患者甚至有更高的过度通气，但没有 EOB。我们试图确定 PH 的肺前毛细血管成分对 PH 和左心疾病患者运动时通气反应的影响。
我们回顾性比较了特发性或遗传性肺动脉高压（PAH，n=29）、孤立性毛细血管后 PH（IpcPH，n=29）和复合后-前毛细血管 PH（CpcPH，n=12）患者。舒张期压力梯度（DPG=舒张期肺动脉压-肺楔压）用于区分 IpcPH（DPG<7mmHg）和 CpcPH（DPG≥7mmHg）。
PAH 患者的肺血管阻力（PVR）较高，CpcPH 患者的 PVR 中等，IpcPH 患者的 PVR 较低。但所有 CpcPH 患者中，只有 1 名患者的 PVR>3 伍德单位。运动引起的过度通气（高分钟通气量超过二氧化碳产生量，低呼气末二氧化碳）在 PAH 患者中明显，在 CpcPH 患者中中等，在 IpcPH 患者中较低（p<0.001），与 DPG 和 PVR 相关。EOB 的患病率从 IpcPH 到 CpcPH 再到 PAH 逐渐降低（p<0.001）。
与 IpcPH 患者相比，CpcPH 患者的血流动力学可能更差，并且通气控制有明显改变，这与运动引起的过度通气增加和 EOB 减少相一致。这至少部分可以解释为肺血管疾病的存在和程度。
