心力衰竭患者的被动抬腿试验可预测运动引起的左心室充盈压升高。

Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures.

机构信息

Department of Public Health and Clinical Medicine, Cardiology, Umeå University, S-90185, Umeå, Sweden.

Department of Medical Sciences,Cardiology, Uppsala University, Uppsala, Sweden.

出版信息

Clin Res Cardiol. 2020 Apr;109(4):498-507. doi: 10.1007/s00392-019-01531-w. Epub 2019 Jul 31.

AIM

The aim of this study was to assess PCWP with passive leg-lifting (PLL) and exercise, in two groups of patients presenting with normal left ventricular ejection fraction (LVEF); one group with elevated NT-proBNP (eBNP), and one with normal NT-proBNP (nBNP) plasma concentration.

METHODS AND RESULTS

Fifty-one patients with eBNP (NT-proBNP ≥ 125 ng/l) and LVEF > 50%, were investigated and compared with 34 patients with nBNP (NT-proBNP < 125 ng/l) and LVEF > 50%. Both groups underwent right heart catheterization (RHC) at rest, PLL and exercise. From RHC, mean pulmonary arterial pressure (mPAP), cardiac output (CO), and PCWP were measured. All nBNP patients had PCWP < 15 mmHg at rest, and a PCWP of < 25 mmHg with PLL and during exercise. Patients with eBNP had higher (p < 0.01) resting mPAP, PCWP, and mPAP/CO. These values increased with exercise; however, CO increased less in comparison with nBNP patients (p = 0.001). 20% of patients with eBNP had a PCWP > 15 mmHg at rest, this percentage increased to 47% with PLL and 41% had a PCWP > 25 mmHg during exercise. Of those with PCWP > 25 mmHg during exercise, 91% had a PCWP > 15 mmHg with PLL. A PCWP > 15 mmHg on PLL had a 91% sensitivity and 92% specificity in predicting exercise-induced PCWP of > 25 mmHg.

CONCLUSION

In patients presenting with eBNP, PLL can predict which patients will develop elevated PCWP with exercise. These findings highlight the role of stress assessment.

目的

本研究旨在评估左心室射血分数（LVEF）正常的两组患者中，被动抬腿（PLL）和运动时肺动脉楔压（PCWP）的变化，一组患者的 N 末端脑利钠肽前体（NT-proBNP）升高（eBNP），另一组患者的 NT-proBNP 正常（nBNP）。

方法和结果

研究共纳入 51 例 eBNP（NT-proBNP≥125ng/l）且 LVEF＞50%的患者，并与 34 例 nBNP（NT-proBNP＜125ng/l）且 LVEF＞50%的患者进行比较。两组患者均接受右心导管检查（RHC），包括静息状态、PLL 和运动状态。通过 RHC 测量平均肺动脉压（mPAP）、心输出量（CO）和 PCWP。所有 nBNP 患者在静息时 PCWP＜15mmHg，PLL 时和运动时 PCWP＜25mmHg。eBNP 患者的静息 mPAP、PCWP 和 mPAP/CO 更高（p＜0.01）。这些值随运动而增加；然而，与 nBNP 患者相比，CO 增加较少（p＝0.001）。20%的 eBNP 患者在静息时 PCWP＞15mmHg，这一比例在 PLL 时增加到 47%，在运动时增加到 41%。在运动时 PCWP＞25mmHg 的患者中，91%的患者在 PLL 时 PCWP＞15mmHg。PLL 时 PCWP＞15mmHg 的预测运动时 PCWP＞25mmHg 的灵敏度为 91%，特异性为 92%。