Zorzi Maria F, Cancelli Emmanuelle, Rusca Marco, Kirsch Matthias, Yerly Patrick, Liaudet Lucas
Service of Adult Intensive Care Medicine, University Hospital, Lausanne, Switzerland.
Service of Cardiac Surgery, Lausanne, Switzerland.
Pulm Circ. 2019 Sep 19;9(3):2045894019877161. doi: 10.1177/2045894019877161. eCollection 2019 Jul-Sep.
The aim of this study was to evaluate the pathophysiological role and the prognostic significance of pulmonary artery compliance (C), a measure of right ventricular pulsatile afterload, in cardiogenic shock. We retrospectively included 91 consecutive patients with cardiogenic shock due to primary left ventricular failure, monitored with a pulmonary artery catheter within the first 24 h. C was calculated as the ratio of stroke volume to pulmonary artery pulse pressure, and we determined whether C predicted mortality and whether it performed better than other pulmonary hemodynamic variables. The overall in-hospital mortality in our cohort was 27%. Survivors and nonsurvivors had comparable left ventricular ejection fraction, systolic, diastolic and mean pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, and pulmonary vascular resistance at 24 h. In contrast, C was the only pulmonary artery variable significantly associated with mortality in univariate and multivariate analyses. Mortality increased from 4.5% at the highest quartile of C (3.6-6.5 mL/mmHg) to 43.5% at the lowest quartile (0.7-1.7 mL/mmHg). In 64 patients with a PAC inserted immediately upon admission, we calculated the trend of C between admission and 24 h. This trend was positive in survivors (+0.8 ± 1.3 ml/mmHg) but negative in nonsurvivors (-0.1 ± 1.0 mL/mmHg). The lower C in nonsurvivors was associated with more severe right ventricular systolic dysfunction. In conclusion, a reduced compliance of the pulmonary artery promotes right ventricular dysfunction and is independently associated with mortality in cardiogenic shock. Future studies should evaluate the impact on pulmonary arterial compliance and right ventricular afterload of therapies used in cardiogenic shock.
本研究旨在评估肺动脉顺应性（C）这一右心室搏动性后负荷指标在心源性休克中的病理生理作用及预后意义。我们回顾性纳入了91例因原发性左心室衰竭导致的心源性休克患者，这些患者在最初24小时内接受了肺动脉导管监测。C计算为每搏量与肺动脉脉压之比，我们确定C是否能预测死亡率，以及它是否比其他肺血流动力学变量表现更好。我们队列中的总体院内死亡率为27%。幸存者和非幸存者在24小时时的左心室射血分数、收缩压、舒张压和平均肺动脉压、跨肺压差、舒张压梯度和肺血管阻力相当。相比之下，在单变量和多变量分析中，C是唯一与死亡率显著相关的肺动脉变量。死亡率从C最高四分位数（3.6 - 6.5 mL/mmHg）时的4.5%增加到最低四分位数（0.7 - 1.7 mL/mmHg）时的43.5%。在64例入院时立即插入肺动脉导管的患者中，我们计算了入院时和24小时之间C的变化趋势。这种趋势在幸存者中为正（+0.8±1.3 ml/mmHg），而在非幸存者中为负（-0.1±1.0 mL/mmHg）。非幸存者中较低的C与更严重的右心室收缩功能障碍相关。总之，肺动脉顺应性降低会促进右心室功能障碍，并在心源性休克中与死亡率独立相关。未来的研究应评估心源性休克治疗对肺动脉顺应性和右心室后负荷的影响。
