Miyanaga Sunao, Kubota Kayoko, Iwatani Noriko, Higo Kenjuro, Miyata Masaaki, Horizoe Yoshihisa, Ojima Satoko, Kawasoe Shin, Kubozono Takuro, Ohishi Mitsuru
Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Heart Vessels. 2019 Sep;34(9):1509-1518. doi: 10.1007/s00380-019-01373-6. Epub 2019 Mar 23.
Screening and early detection of pulmonary arterial hypertension (PAH) in connective tissue disease (CTD) are currently recommended for early treatment. Exercise-induced pulmonary hypertension (EIPH) is thought to be a potential risk of developing resting pulmonary hypertension. However, accurate diagnosis of EIPH is needed hemodynamics by right heart catheterization during exercise. Therefore, we compared various parameters of EIPH group with non-EIPH group in patients with CTD. This study aimed to investigate noninvasive predictors of EIPH. A total of 162 consecutive patients with CTD who received screening of PAH was studied. Thirty-four patients with suspected PAH received right heart catheterization (RHC) at rest. Twenty-four patients without PAH underwent RHC during exercise, and they were divided into the EIPH group (n = 7) and the non-EIPH group (n = 17). Exercise tolerance such as 6-min walk distance and peak VO/kg in the EIPH group was lower than that in the non-EIPH group. For hemodynamics, pulmonary artery pressure, right atrial pressure, and vascular resistance in the EIPH group were significantly higher than those in the non-EIPH group. In echocardiography, RV Tei index in the EIPH group was significantly higher than that in the non-EIPH group (EIPH vs non-EIPH = 0.42 [0.41, 0.47] vs 0.25 [0.20, 0.32], P = 0.007). The receiver operating characteristics curve showed a cutoff value of RV Tei index (0.41) with a sensitivity of 0.857 and specificity of 0.882. In conclusion, RV Tei index might be a feasible predictor of EIPH in patients with CTD.
目前建议对结缔组织病（CTD）患者进行肺动脉高压（PAH）的筛查和早期检测，以便早期治疗。运动性肺动脉高压（EIPH）被认为是发生静息性肺动脉高压的潜在风险。然而，需要通过运动时右心导管检查进行血流动力学检查才能准确诊断EIPH。因此，我们比较了CTD患者中EIPH组和非EIPH组的各种参数。本研究旨在探讨EIPH的无创预测指标。共研究了162例连续接受PAH筛查的CTD患者。34例疑似PAH患者在静息状态下接受了右心导管检查（RHC）。24例无PAH患者在运动时接受了RHC，并分为EIPH组（n = 7）和非EIPH组（n = 17）。EIPH组的运动耐量，如6分钟步行距离和峰值VO₂/kg低于非EIPH组。在血流动力学方面，EIPH组的肺动脉压、右心房压和血管阻力显著高于非EIPH组。在超声心动图检查中，EIPH组的右室Tei指数显著高于非EIPH组（EIPH组与非EIPH组分别为0.42[0.41, 0.47]和0.25[0.20, 0.32]，P = 0.007）。受试者工作特征曲线显示右室Tei指数的截断值为0.41，敏感性为0.857，特异性为0.882。总之，右室Tei指数可能是CTD患者EIPH的一个可行预测指标。
