黄金比例与肺动脉高压中肺压成分的比例关系。

Golden Ratio and the Proportionality Between Pulmonary Pressure Components in Pulmonary Arterial Hypertension.

机构信息

Service d'Explorations Fonctionnelles Multidisciplinaires Bi-site Antoine Béclère - Le Kremlin-Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, France.

出版信息

Chest. 2019 May;155(5):991-998. doi: 10.1016/j.chest.2018.12.006. Epub 2018 Dec 27.

DOI:10.1016/j.chest.2018.12.006

PMID:30594558

Abstract

BACKGROUND

The golden ratio (phi, Φ = 1.618) is a proportion that has been found in many phenomena in nature, including the cardiovascular field. We tested the hypothesis that the systolic over mean pulmonary artery pressure ratio (sPAP/mPAP) and the mean over diastolic pressure ratio (mPAP/dPAP) may match Φ in patients with pulmonary arterial hypertension (PAH) and in control patients.

METHODS

In the first, theoretical part of the study, we discuss why our hypothesis is consistent with three known hemodynamic features of the pulmonary circulation: (1) the 0.61 slope of the mPAP vs sPAP relationship, (2) pulmonary artery pulse pressure and mPAP have an almost 1:1 ratio, and (3) the proportional relationship among sPAP, mPAP, and dPAP. In the second part of the study, fluid-filled pressures were analyzed in 981 incident, untreated PAH and high-fidelity pressures were also analyzed in 44 historical control patients (mPAP range, 9-113 mm Hg).

RESULTS

In PAH (non-normal distribution), median values of sPAP/mPAP and mPAP/dPAP were 1.591 (98%Φ) and 1.559 (96%Φ), respectively. In control patients (normal distribution), mean sPAP/mPAP and mPAP/dPAP were 1.572 (97%Φ) and 1.470 (91%Φ), respectively. In both PAH and control patients, this was consistent with the Φ hypothesis, assuming < 1 mm Hg error in estimation of sPAP, mPAP, and dPAP on average.

CONCLUSIONS

In PAH and in control patients, the fluctuations in sPAP and dPAP around mPAP exhibited a constant scaling factor matched to Φ. This remarkable property allows linkage of various empirical observations on pulmonary hemodynamics that were hitherto apparently unrelated. These findings warrant further confirmation in other types of pulmonary hypertension and warrant explanation.

摘要

背景

黄金比例（phi，Φ=1.618）是自然界中许多现象中存在的比例，包括心血管领域。我们测试了以下假设，即在肺动脉高压（PAH）患者和对照患者中，收缩压与平均肺动脉压之比（sPAP/mPAP）和平均压与舒张压之比（mPAP/dPAP）可能与Φ匹配。

方法

在研究的第一部分，理论部分，我们讨论了为什么我们的假设与肺循环的三个已知血流动力学特征一致：（1）mPAP 与 sPAP 关系的 0.61 斜率，（2）肺动脉脉冲压和 mPAP 几乎为 1:1 比，以及（3）sPAP、mPAP 和 dPAP 之间的比例关系。在研究的第二部分，分析了 981 例未经治疗的 PAH 患者的充液压力，并对 44 例历史对照患者的高保真压力进行了分析（mPAP 范围为 9-113mmHg）。

结果

在 PAH（非正态分布）中，sPAP/mPAP 和 mPAP/dPAP 的中位数分别为 1.591（98%Φ）和 1.559（96%Φ）。在对照患者（正态分布）中，sPAP/mPAP 和 mPAP/dPAP 的平均值分别为 1.572（97%Φ）和 1.470（91%Φ）。在 PAH 和对照患者中，这与 Φ 假设一致，假设平均而言，sPAP、mPAP 和 dPAP 的估计值误差<1mmHg。