Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences.
Department of Clinical Laboratory, Kagoshima University Medical and Dental Hospital.
Circ J. 2019 May 24;83(6):1278-1285. doi: 10.1253/circj.CJ-18-1155. Epub 2019 Apr 9.
This study was designed to investigate the relationship between right ventricular wall stress (RVWS) and plasma B-type natriuretic peptide (BNP) levels in patients with pulmonary hypertension (PH).
The 57 consecutive PH patients and 8 control subjects were enrolled. Right heart catheterization (RHC), echocardiography, and BNP measurements were performed, and RVWS and left ventricular wall stress (LVWS) were calculated with the formula based on Laplace's law. Systolic RVWS and end-diastolic RVWS were higher in PH patients compared with controls (systolic RVWS: 77±41 vs. 17±5 kdynes/cm(P<0.0001), end-diastolic RVWS: 15±12 vs. 8±2 kdynes/cm(P<0.0005)). Univariate analyses showed that logBNP at baseline correlated with systolic RVWS (r=0.58, P<0.0001) and end-diastolic RVWS (r=0.61, P<0.0001). We performed multivariate regression analysis and determined that end-diastolic RVWS was an independent determinant of logBNP in patients with PH. In addition, change in plasma BNP levels after treatment correlated with change in systolic RVWS (r=0.70, P<0.0001) and change in end-diastolic RVWS (r=0.68, P<0.0001).
Both systolic and end-diastolic RVWS were elevated in patients with PH, and correlated with the symptoms of PH. End-diastolic RVWS was an independent determinant of plasma BNP levels in PH patients.
本研究旨在探讨肺动脉高压（PH）患者右心室壁应力（RVWS）与血浆 B 型利钠肽（BNP）水平的关系。
共纳入 57 例连续 PH 患者和 8 例对照者。进行右心导管检查（RHC）、超声心动图和 BNP 测量，并根据拉普拉斯定律的公式计算 RVWS 和左心室壁应力（LVWS）。与对照组相比，PH 患者的收缩期 RVWS 和舒张末期 RVWS 更高（收缩期 RVWS：77±41 对 17±5 kdynes/cm（P<0.0001），舒张末期 RVWS：15±12 对 8±2 kdynes/cm（P<0.0005））。单因素分析显示，基线时 logBNP 与收缩期 RVWS（r=0.58，P<0.0001）和舒张末期 RVWS（r=0.61，P<0.0001）相关。我们进行了多变量回归分析，确定舒张末期 RVWS 是 PH 患者 logBNP 的独立决定因素。此外，治疗后血浆 BNP 水平的变化与收缩期 RVWS 的变化（r=0.70，P<0.0001）和舒张末期 RVWS 的变化（r=0.68，P<0.0001）相关。
PH 患者的收缩期和舒张末期 RVWS 均升高，并与 PH 的症状相关。舒张末期 RVWS 是 PH 患者血浆 BNP 水平的独立决定因素。
