Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine.
Circ J. 2019 Oct 25;83(11):2222-2228. doi: 10.1253/circj.CJ-19-0316. Epub 2019 Sep 5.
Pulmonary arterial capacitance (PAC) is a determinant of right ventricular afterload and a strong independent predictor of unfavorable outcomes in advanced heart failure (HF) with pulmonary hypertension (PH). We aimed to test the hypothesis that preoperative PAC may affect postoperative clinical outcomes in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS), even in the absence of PH.
We studied 116 patients who underwent AVR for severe AS between January 2005 and December 2017. Right heart catheterization was performed for all patients prior to surgery. PAC and pulmonary vascular resistance (PVR) fit well to a hyperbolic relationship (PAC=0.23/PVR, R=0.73). PAC also showed an inverse relationship with pulmonary capillary wedge pressure (PCWP) (r=-0.15) and mean pulmonary arterial pressure (r=-0.29) and provided a stronger prediction of death or HF admission than PCWP or PVR (area under the ROC curve of 0.74 vs. 0.40 and 0.41, respectively, P=0.002). During a median follow-up of 36 months, PAC (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P=0.003) was an independent predictor of death or hospitalization for HF.
In these patients undergoing AVR for severe AS, even in the absence of PH, preoperative reduced PAC was independently associated with adverse surgical outcomes. It seems that preoperative PAC has potential as an independent predictor of long-term prognosis after AVR for severe AS.
肺血管顺应性（PAC）是右心室后负荷的决定因素，也是肺动脉高压（PH）合并晚期心力衰竭（HF）不良结局的强有力独立预测因子。我们旨在检验这样一个假设，即对于因严重主动脉瓣狭窄（AS）而行主动脉瓣置换术（AVR）的患者，即使不存在 PH，术前 PAC 可能会影响术后临床结局。
我们研究了 2005 年 1 月至 2017 年 12 月期间因严重 AS 而行 AVR 的 116 例患者。所有患者在手术前均进行了右心导管检查。PAC 和肺血管阻力（PVR）拟合良好呈双曲线关系（PAC=0.23/PVR，R=0.73）。PAC 还与肺毛细血管楔压（PCWP）呈负相关（r=-0.15），与平均肺动脉压（r=-0.29）呈负相关，且比 PCWP 或 PVR 能更好地预测死亡或 HF 入院（ROC 曲线下面积分别为 0.74、0.40 和 0.41，P=0.002）。在中位数为 36 个月的随访期间，PAC（风险比，0.48；95%置信区间，0.30-0.78；P=0.003）是死亡或 HF 住院的独立预测因子。
在这些因严重 AS 而行 AVR 的患者中，即使不存在 PH，术前 PAC 降低与不良手术结局独立相关。术前 PAC 似乎有作为严重 AS 行 AVR 后长期预后的独立预测因子的潜力。
