Hamatani Yasuhiro, Amaki Makoto, Yonezawa Rika, Yanagi Yoshiki, Jo Yoshito, Amano Masashi, Okada Atsushi, Takahama Hiroyuki, Hasegawa Takuya, Kanzaki Hideaki, Yasuda Satoshi, Izumi Chisato
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
Laboratory of Clinical Physiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Int J Cardiovasc Imaging. 2019 May;35(5):837-844. doi: 10.1007/s10554-018-01522-4. Epub 2019 Jan 8.
Exercise-induced pulmonary hypertension (EIPH) is associated with worse outcomes in patients with heart failure or valvular heart disease. However, little is known regarding the implications of EIPH in hypertrophic cardiomyopathy (HCM) patients. We retrospectively reviewed data of consecutive HCM patients who underwent clinically indicated exercise echocardiography using a semi-supine bicycle ergometer at our hospital. EIPH was defined as pulmonary artery systolic pressure ≥ 60 mmHg during exercise. The incidences of HCM-related mortality and HCM-related morbidity during follow-up period were evaluated. Of 42 patients (mean age 59 ± 21 years; 4 with resting obstruction, 19 with provoked obstruction, and 19 without obstruction), 16 (38%) developed EIPH. Patients with EIPH had significantly longer resting E wave deceleration time (271 ± 116 vs. 213 ± 66 ms; P = 0.04), higher resting pulmonary artery systolic pressure (35 ± 6 vs. 31 ± 5 mmHg; P = 0.04), and higher B-type natriuretic peptide level (283 [222, 465] vs. 142 [54, 423] pg/ml; P = 0.04) than those without EIPH. Kaplan-Meier curve analysis demonstrated that EIPH was significantly associated with HCM-related morbidity (log-rank; P = 0.01). In Cox regression analysis, EIPH was a significant predictor of HCM-related morbidity (hazard ratio: 5.98, 95% confidence interval 1.36-41.07; P = 0.02). In conclusion, EIPH was documented in about one-third of HCM patients. EIPH was a significant predictor of HCM-related morbidity in patients with HCM.
运动诱发性肺动脉高压（EIPH）与心力衰竭或心脏瓣膜病患者的不良预后相关。然而，关于EIPH在肥厚型心肌病（HCM）患者中的影响知之甚少。我们回顾性分析了我院连续接受临床指示的半卧位自行车测力计运动超声心动图检查的HCM患者的数据。EIPH定义为运动期间肺动脉收缩压≥60 mmHg。评估随访期间HCM相关死亡率和HCM相关发病率。42例患者（平均年龄59±21岁；4例静息时有梗阻，19例激发试验时有梗阻，19例无梗阻）中，16例（38%）发生EIPH。与无EIPH的患者相比，EIPH患者的静息E波减速时间显著更长（271±116 vs. 213±66 ms；P = 0.04），静息肺动脉收缩压更高（35±6 vs. 31±5 mmHg；P = 0.04），B型利钠肽水平更高（283 [222, 465] vs. 142 [54, 423] pg/ml；P = 0.04）。Kaplan-Meier曲线分析表明，EIPH与HCM相关发病率显著相关（对数秩检验；P = 0.01）。在Cox回归分析中，EIPH是HCM相关发病率的显著预测因素（风险比：5.98，95%置信区间1.36 - 41.07；P = 0.02）。总之，约三分之一的HCM患者存在EIPH。EIPH是HCM患者HCM相关发病率的显著预测因素。
