Billings Catherine G, Lewis Robert, Armstrong Iain J, Hurdman Judith A, Smith Ian A, Austin Matthew, Elliot Charlie A, Charalampopoulos Athanasios, Sabroe Ian, Lawrie Allan, Thompson A A Roger, Condliffe Robin, Kiely David G
Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, United Kingdom.
Front Med (Lausanne). 2018 Jun 21;5:172. doi: 10.3389/fmed.2018.00172. eCollection 2018.
There is increasing interest in screening for and diagnosing pulmonary hypertension earlier in the course of disease. However, there is limited data on cardiopulmonary abnormalities in patients with pulmonary hypertension newly diagnosed in World Health Organization Function Class (WHO FC) I. Data were retrieved from the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral center) for consecutive treatment naïve patients diagnosed with pulmonary hypertension by cardiac catheterization between 2001 and 2010 who underwent incremental shuttle walk exercise testing. Eight hundred and ninety-five patients were diagnosed with Group 1-5 pulmonary hypertension. Despite the absence of symptoms, patients in WHO FC I ( = 9) had a significant reduction in exercise capacity (Incremental shuttle walk distance percent predicted (ISWD%pred) 65 ± 13%, Z score -1.77 ± 1.05), and modest pulmonary hypertension with a median (interquartile range) pulmonary artery pressure 31(20) mmHg and pulmonary vascular resistance 2.1(8.2) Wood Units, despite a normal diffusion of carbon monoxide adjusted for age and sex (DLco)%pred 99 ± 40%. Compared to patients in WHO FC I, patients in WHO FC II ( = 162) had a lower ISWD%pred 43 ± 22 and lower DLco%pred 65 ± 21%. Our results demonstrate that patients with newly diagnosed pulmonary hypertension with no or minimal symptomatic limitation have a significant reduction of exercise capacity.
在疾病进程中更早地筛查和诊断肺动脉高压受到越来越多的关注。然而，关于世界卫生组织功能分级（WHO FC）I级新诊断的肺动脉高压患者心肺异常的数据有限。数据取自ASPIRE注册研究（评估在转诊中心发现的肺动脉高压谱），纳入了2001年至2010年间通过心脏导管检查诊断为肺动脉高压且未接受过治疗的连续患者，这些患者接受了递增往返步行运动测试。895名患者被诊断为1 - 5组肺动脉高压。尽管没有症状，但WHO FC I级患者（n = 9）的运动能力显著下降（递增往返步行距离预测百分比（ISWD%pred）为65 ± 13%，Z评分为 -1.77 ± 1.05），且存在轻度肺动脉高压，肺动脉压中位数（四分位间距）为31（20）mmHg，肺血管阻力为2.1（8.2）伍德单位，尽管根据年龄和性别调整后的一氧化碳弥散量（DLco）%pred为99 ± 40%。与WHO FC I级患者相比，WHO FC II级患者（n = 162）的ISWD%pred更低，为43 ± 22，DLco%pred也更低，为65 ± 21%。我们的结果表明，新诊断的肺动脉高压且无或仅有轻微症状限制的患者运动能力显著下降。
