Kushimo O A, Mbakwem A C, Ajuluchukwu J N, Amadi C E
Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Nigeria. Email:
Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Nigeria; College of Medicine, University of Lagos, Nigeria.
Cardiovasc J Afr. 2019;30(1):9-14. doi: 10.5830/CVJA-2018-053. Epub 2018 Nov 5.
Pulmonary hypertension (PH) is very prevalent among heart failure (HF) subjects and is now recognised as an independent predictor of poor prognosis. There is a paucity of data in our environment about the frequency and correlates of PH in HF. We aimed to determine the frequency of PH in HF patients in an academic hospital and assess its correlates using echocardiography.
A total of 219 heart failure patients in NYHA functional class II to IV, and without co-morbidities that could cause PH, were consecutively recruited. Demographic, clinical and echocardiographic data were obtained from all subjects.
The frequency of PH was 38.8%, using an estimated pulmonary artery systolic pressure (PASP) cut-off value of > 36 mmHg. HF subjects with PH tended to be male with a worse NYHA functional class compared with subjects without PH. HF subjects with PH also had significantly higher left ventricular (LV) filling pressures (higher left atrial volume index and E/e' ratio), more severe mitral regurgitation (MR), poorer LV systolic function, and worse parameters of right ventricular (RV) structure and function compared with those without PH. Echocardiographic variables that correlated significantly with PASP include LV filling pressures ( < 0.001 for all), mitral regurgitant volume ( = 0.269, < 0.001) and LV ejection fraction ( = -0.239, > 0.001). On multivariate analysis, the left atrial volume index and E/e' ratio were independently associated with PASP.
PH is common among HF subjects in our environment and is associated with higher LV filling pressure, more severe MR, poorer LV systolic function and worse RV remodelling. Routine screening for PH among HF patients is recommended for better risk stratification and management.
肺动脉高压（PH）在心力衰竭（HF）患者中非常普遍，目前被认为是预后不良的独立预测因素。在我们所处的环境中，关于HF患者中PH的发生率及其相关因素的数据较少。我们旨在确定一家学术医院中HF患者的PH发生率，并使用超声心动图评估其相关因素。
连续招募了总共219例纽约心脏协会（NYHA）心功能II至IV级、且无可能导致PH的合并症的心力衰竭患者。从所有受试者获取人口统计学、临床和超声心动图数据。
使用估计的肺动脉收缩压（PASP）截断值>36 mmHg时，PH的发生率为38.8%。与无PH的受试者相比，有PH的HF受试者往往为男性，NYHA心功能分级更差。与无PH的受试者相比，有PH的HF受试者还具有显著更高的左心室（LV）充盈压（更高的左心房容积指数和E/e'比值）、更严重的二尖瓣反流（MR）、更差的LV收缩功能以及右心室（RV）结构和功能参数。与PASP显著相关的超声心动图变量包括LV充盈压（所有P<0.001）、二尖瓣反流容积（r = 0.269，P<0.001）和LV射血分数（r = -0.239，P>0.001）。多变量分析显示，左心房容积指数和E/e'比值与PASP独立相关。
在我们所处的环境中，PH在HF受试者中很常见，并且与更高的LV充盈压、更严重的MR、更差的LV收缩功能和更差的RV重塑相关。建议对HF患者进行PH的常规筛查，以实现更好的风险分层和管理。
