Greiner Sebastian, Jud Andreas, Aurich Matthias, Geisenberger Christoph, Uhlmann Lorenz, Hilbel Thomas, Kieser Meinhard, Katus Hugo A, Mereles Derliz
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
Division of Experimental Neurosurgery, University of Heidelberg, Heidelberg, Germany.
PLoS One. 2018 Jan 19;13(1):e0191206. doi: 10.1371/journal.pone.0191206. eCollection 2018.
The clinical relevance of non-invasively derived pulmonary arterial pressure (PAP) by Doppler echocardiography (DE) has been questioned in the past. However, transthoracic echocardiography is used as a cornerstone examination for patients with dyspnea and suspected pulmonary hypertension (PH). This study aimed to evaluate the prognostic value of non-invasive assessed PAP in a large population of patients with known or suspected cardiopulmonary disease.
The analyses are based on data of patients of a tertiary cardiology center that received right heart catheterization (RHC) as well as non-invasively assessed PAP by DE within five days, and includes serological and clinical parameters in a retrospective follow-up for up to eight years.
Of 1,237 patients, clinical follow-up was possible in 1,038 patients who were included in the statistical analysis. The mean-follow up time was 1,002 days. The composite endpoint of heart transplantation (HTx) or death occurred in n = 308 patients. Elevated PAP measured non-invasively as well as invasively had significant prognostic impact (hazard ratio (HR) 2.32; 95% confidence interval (CI) 1.78-3.04; χ2 = 37.9; p<0.001 versus HR 2.84; 95%CI 2.11-3.82; χ2 = 51.9; p<0.001, respectively). By multivariate analysis, NYHA functional class, N-terminal pro-brain natriuretic peptide, cardiac troponin T, left ventricular ejection fraction, and right ventricular dysfunction remained independently predictive. Incremental prognostic information in a multimodal approach was highly relevant.
In this comprehensive study, elevated pulmonary arterial pressure measured by DE offers similar prognostic information on survival or need for HTx as right heart catheterization. Furthermore, the addition of functional capacity and serological biomarkers delivered incremental prognostic information.
过去，经多普勒超声心动图（DE）无创得出的肺动脉压（PAP）的临床相关性一直受到质疑。然而，经胸超声心动图被用作呼吸困难和疑似肺动脉高压（PH）患者的一项基础检查。本研究旨在评估在大量已知或疑似心肺疾病患者中，无创评估的PAP的预后价值。
分析基于一家三级心脏病中心患者的数据，这些患者在五天内接受了右心导管检查（RHC）以及通过DE无创评估的PAP，并在长达八年的回顾性随访中纳入了血清学和临床参数。
在1237例患者中，1038例患者可进行临床随访并纳入统计分析。平均随访时间为1002天。n = 308例患者发生了心脏移植（HTx）或死亡的复合终点事件。无创和有创测量的升高的PAP均具有显著的预后影响（风险比（HR）分别为2.32；95%置信区间（CI）为1.78 - 3.04；χ2 = 37.9；p < 0.001，以及HR 2.84；95%CI为2.11 - 3.82；χ2 = 51.9；p < 0.001）。通过多变量分析，纽约心脏协会（NYHA）功能分级、N末端脑钠肽前体、心肌肌钙蛋白T、左心室射血分数和右心室功能障碍仍然具有独立预测性。多模式方法中的增量预后信息高度相关。
在这项全面的研究中，通过DE测量的升高的肺动脉压提供了与右心导管检查相似的关于生存或HTx需求的预后信息。此外，功能能力和血清学生物标志物的加入提供了增量预后信息。
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