Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
J Card Fail. 2018 Sep;24(9):575-582. doi: 10.1016/j.cardfail.2018.08.003. Epub 2018 Aug 10.
Decoupling between diastolic pulmonary arterial pressure (dPAP) and pulmonary arterial wedge pressure (PAWP) is an index of pulmonary vasculature remodeling and provides prognostic information. Furthermore, decoupling may change during incremental left ventricular assist device (LVAD) speed changes.
In this prospective study, patients underwent an echocardiographic and hemodynamic ramp test after LVAD implantation and were followed for 1 year. The change in decoupling (dPAP - PAWP) between the lowest and highest LVAD speeds during the ramp test was calculated. Survival and heart failure admission rates were assessed by means of Kaplan-Meier analysis. Eighty-seven patients were enrolled in the study: 54 had a Heartmate II LVAD (60.8 ± 9.3 years of age and 34 male) and 33 had an HVAD LVAD (58.6 ± 13.2 years of age and 20 male). Patients who experienced greater changes in decoupling (Δdecoupling >3 mm Hg) had a persistently elevated dPAP at incremental LVAD speed and had worse 1-year heart failure readmission-free survival compared with the group without significant changes in the degree of decoupling (41% vs 75%; P = .001).
An increase in decoupling between dPAP and PAWP at incremental LVAD speed changes was associated with worse prognosis in LVAD patients.
舒张期肺动脉压（dPAP）与肺动脉楔压（PAWP）解耦是肺血管重构的指标，并提供预后信息。此外，解耦可能会在左心室辅助装置（LVAD）速度递增变化期间发生变化。
在这项前瞻性研究中，患者在 LVAD 植入后接受超声心动图和血流动力学斜坡试验，并随访 1 年。计算斜坡试验中最低和最高 LVAD 速度之间解耦（dPAP-PAWP）的变化。通过 Kaplan-Meier 分析评估生存率和心力衰竭入院率。研究共纳入 87 例患者：54 例使用 Heartmate II LVAD（60.8±9.3 岁，34 例男性），33 例使用 HVAD LVAD（58.6±13.2 岁，20 例男性）。与解耦程度无明显变化的组相比，解耦变化较大（Δdecoupling >3mmHg）的患者在递增 LVAD 速度时持续升高的 dPAP，1 年心力衰竭无再入院生存率较差（41%比 75%；P=0.001）。
递增 LVAD 速度变化时 dPAP 与 PAWP 之间解耦的增加与 LVAD 患者的预后较差相关。
