Minatsuki Shun, Hatano Masaru, Maki Hisataka, Takimoto Eiki, Morita Hiroyuki, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo.
Int Heart J. 2019 Sep 27;60(5):1137-1141. doi: 10.1536/ihj.19-079. Epub 2019 Sep 4.
Current therapeutic methods for chronic thromboembolic pulmonary hypertension (CTEPH) can improve hemodynamic status and are expected to improve prognoses. However, some patients experience dyspnea during effort and continue supplemental oxygenation despite their hemodynamic status being fully improved. Considering the pathogenesis of CTEPH, the dead space and intrapulmonary shunt are assumed to be responsible for hypoxia in CTEPH, but their contributions are unclear. It is also unclear whether they are improved after treatment. The aim of this study was to investigate the implications of the dead space ratio (DSR) and the intrapulmonary shunt ratio (ISR) for hypoxia in CTEPH and treatment for CTEPH.We retrospectively measured the DSR and ISR of 23 consecutive patients with CTEPH. For 11 of these 23 (10 were treated by balloon pulmonary angioplasty, one with riociguat), we also measured these parameters before and after CTEPH treatments. Overall, the DSR and ISR were abnormally elevated (DSR: 0.63 ± 0.06; ISR: 0.20 ± 0.05). After treatment, mean pulmonary artery pressure was improved (from 40.3 ± 8.1 to 25.5 ± 2.7 mmHg). Although atrial oxygen saturation (SaO), DSR and ISR were improved (SaO: from 90.2 ± 3.2 to 93.7 ± 1.8%; DSR: from 0.64 ± 0.06 to 0.58 ± 0.05; ISR: from 0.20 ± 0.04 to 0.18 ± 0.02), these improvements were slight compared with that of mean pulmonary artery pressure.The DSR and ISR were abnormally elevated in patients with CTEPH and their improvement by treatment was limited. Only DSR can be a useful marker for normalization of hypoxia in CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）的现有治疗方法可改善血流动力学状态，并有望改善预后。然而，一些患者在活动时仍会出现呼吸困难，尽管其血流动力学状态已完全改善，但仍需持续吸氧。考虑到CTEPH的发病机制，无效腔和肺内分流被认为是导致CTEPH患者缺氧的原因，但其具体作用尚不清楚。治疗后这些因素是否改善也不明确。本研究的目的是探讨无效腔比率（DSR）和肺内分流比率（ISR）在CTEPH患者缺氧及CTEPH治疗中的意义。我们回顾性测量了23例连续CTEPH患者的DSR和ISR。在这23例患者中的11例（10例接受了球囊肺动脉血管成形术治疗，1例接受了利奥西呱治疗），我们还在CTEPH治疗前后测量了这些参数。总体而言，DSR和ISR异常升高（DSR：0.63±0.06；ISR：0.20±0.05）。治疗后，平均肺动脉压有所改善（从40.3±8.1降至25.5±2.7 mmHg）。虽然动脉血氧饱和度（SaO）、DSR和ISR有所改善（SaO：从90.2±3.2升至93.7±1.8%；DSR：从0.64±0.06降至0.58±0.05；ISR：从0.20±0.04降至0.18±0.02），但与平均肺动脉压的改善相比，这些改善较为轻微。CTEPH患者的DSR和ISR异常升高，治疗后其改善有限。只有DSR可作为CTEPH患者缺氧正常化的有用标志物。
