慢性血栓栓塞性肺动脉高压患者经球囊肺动脉血管成形术后右心室肥厚相关心电图的改善。

Improvement in the electrocardiograms associated with right ventricular hypertrophy after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension.

作者信息

Nishiyama Takahiko, Takatsuki Seiji, Kawakami Takashi, Katsumata Yoshinori, Kimura Takehiro, Kataoka Masaharu, Tsuruta Hikaru, Itabashi Yuji, Murata Mitsushige, Yuasa Shinsuke, Aizawa Yoshiyasu, Fukuda Keiichi

机构信息

Department of Cardiology, Keio University School of Medicine, Japan.

出版信息

Int J Cardiol Heart Vasc. 2018 May 25;19:75-82. doi: 10.1016/j.ijcha.2018.05.003. eCollection 2018 Jun.

BACKGROUND

Balloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS AND RESULTS

In 60 patients with CTEPH, we examined the hemodynamic data before and after BPA. In addition, the sequential ECG findings for right ventricular hypertrophy (RVH) were assessed. The mean pulmonary arterial pressure (mPAP) decreased from 38 ± 11 to 20 ± 4 mm Hg (p < 0.05). The ROC analysis showed that the S waves in V5, R waves in V1 + S waves in V5, S waves in I, and QRS axis were significant predictors of an mPAP ≧ 30 mm Hg (AUC > 0.75, p < 0.01). The predictive values for the mPAP before the BPA were the S and R waves in lead V6, and P waves in lead II (33.417 + 0.078 × P in II - 0.10 × R in V6 + 0.012 × S in V6). The change in the mPAP (ΔmPAP) correlated with the change in the amplitudes of the ECGs: ΔS wave in lead I (R = 0.544, p < 0.001), ΔR in V1 + S in V5 (R = 0.476, p < 0.001), and ΔP wave in II (R = 0.511, p < 0.001). At 6 months of follow-up, the improvement in an R in V1 + S in V5 of ≧10 mm implied a better functional status.

CONCLUSION

BPA therapy reduced the pulmonary arterial pressure in patients with CTEPH and was associated with an improvement in the ECG findings related to RVH.

背景

球囊肺动脉血管成形术（BPA）是慢性血栓栓塞性肺动脉高压（CTEPH）患者的一种治疗选择。

方法与结果

在60例CTEPH患者中，我们检查了BPA前后的血流动力学数据。此外，还评估了右心室肥厚（RVH）的连续心电图表现。平均肺动脉压（mPAP）从38±11降至20±4 mmHg（p<0.05）。ROC分析显示，V5导联的S波、V1导联的R波+V5导联的S波、I导联的S波和QRS电轴是mPAP≧30 mmHg的显著预测指标（AUC>0.75，p<0.01）。BPA前mPAP的预测值为V6导联的S波和R波以及II导联的P波（33.417 + 0.078×II导联的P波 - 0.10×V6导联的R波 + 0.012×V6导联的S波）。mPAP的变化（ΔmPAP）与心电图振幅的变化相关：I导联的ΔS波（R = 0.544，p<0.001）、V1导联的ΔR + V5导联的S波（R = 0.476，p<0.001）以及II导联的ΔP波（R = 0.511，p<0.001）。在随访6个月时，V1导联的R波+V5导联的S波改善≧10 mm意味着功能状态更好。