Chen Peng-Yuan, Luo Dong-Ling, Li He-Zhi, Fei Hong-Wen, Huang Tao, Huang Yi-Gao, Chen Ji-Mei, Zhuang Jian, He Peng-Cheng, Zhang Cao-Jin
Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China.
Department of Echo Room, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
Pulm Circ. 2019 Nov 15;9(4):2045894019888428. doi: 10.1177/2045894019888428. eCollection 2019 Oct-Dec.
The present study aimed to propose the pulmonary hypertension for predicting left ventricular dysfunction in adults after patent ductus arteriosus closure. A total of 183 patients (age ≥18 years) after patent ductus arteriosus occlusion were retrospectively collected in this study. In brief, pre-, post-procedure and short-term follow-up transthoracic echocardiography were performed. Simpson's method was used to measure the left ventricular ejection fraction (LVEF), and LVEF less than 50% after procedure was utilized as a criterion to identify left ventricular dysfunction. As a result, 36 (19.67%) patients developed newly identified left ventricular dysfunction. The rate of newly identified left ventricular dysfunction was significantly higher in moderate or severe pulmonary hypertension groups compared to the groups of mean pulmonary artery pressure (mPAP) <25 mmHg (P < .001). Logistic regression analysis showed that elevated mPAP ( ≥25 mmHg) was an independent predictive value for newly identified left ventricular dysfunction (OR = 3.584, 95%CI: 1.186-10.832, P = .024) after adjusting confounders. The ROC curve revealed a good discrimination power for predicting newly identified left ventricular dysfunction (AUC = 0.924, 95%CI: 0.885-0.963, P < .001). Taken together, newly identified left ventricular dysfunction after patent ductus arteriosus closure was prevalent in patients with elevated mPAP. The pre-procedure elevated mPAP is an independent risk factor for the prediction of the newly identified left ventricular dysfunction in adult patients undergoing percutaneous patent ductus arteriosus closure. It is feasible to propose a risk model for predicting post-procedure left ventricular dysfunction and a heart function monitoring in pulmonary hypertension patients.
本研究旨在提出用肺动脉高压来预测动脉导管未闭封堵术后成人左心室功能障碍。本研究回顾性收集了183例（年龄≥18岁）动脉导管未闭封堵术后患者。简而言之，进行了术前、术后及短期随访经胸超声心动图检查。采用Simpson法测量左心室射血分数（LVEF），并将术后LVEF小于50%作为识别左心室功能障碍的标准。结果，36例（19.67%）患者出现新诊断的左心室功能障碍。与平均肺动脉压（mPAP）<25 mmHg的组相比，中度或重度肺动脉高压组新诊断的左心室功能障碍发生率显著更高（P<0.001）。逻辑回归分析显示，校正混杂因素后，mPAP升高（≥25 mmHg）是新诊断左心室功能障碍的独立预测指标（OR=3.584，95%CI：1.186-10.832，P=0.024）。ROC曲线显示对预测新诊断的左心室功能障碍具有良好的鉴别能力（AUC=0.924，95%CI：0.885-0.963，P<0.001）。综上所述，动脉导管未闭封堵术后新诊断的左心室功能障碍在mPAP升高的患者中很常见。术前mPAP升高是预测接受经皮动脉导管未闭封堵术的成年患者新诊断左心室功能障碍的独立危险因素。提出一个预测术后左心室功能障碍的风险模型以及对肺动脉高压患者进行心功能监测是可行的。
