Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada.
School of Biomedical Engineering, Western University, London, Ontario, Canada.
J Heart Lung Transplant. 2020 Jul;39(7):657-665. doi: 10.1016/j.healun.2020.02.013. Epub 2020 Feb 24.
The objectives of this study were to describe right ventricular-pulmonary arterial elastance coupling hemodynamic phenotypes and their frequency in patients with advanced heart failure and to evaluate the association of elastance-based indices with all-cause mortality, cardiac transplantation, and left ventricular assist device therapy.
This study included 175 patients with heart failure undergoing right heart catheterization to evaluate candidacy for advanced therapies and 21 healthy controls. We modified a single-beat approach to elastance to account for the magnitude of pulmonary arterial pressure and estimated right ventricular end-systolic elastance (E), pulmonary arterial elastance (E), and the E:E ratio. We defined elevated pulmonary arterial load as an E > 0.5 mm Hg/ml, and ventriculo-arterial uncoupling as an E:E < 0.8. We evaluated associations between E, E, and E:E with all-cause mortality and composite event-free survival using multivariable Cox proportional-hazard models, adjusted for age and sex.
All 21 controls had E ≤ 0.5 mm Hg/ml and E:E ≥ 0.8. Of 175 patients with heart failure, 63% had E > 0.5 mm Hg/ml. E:E was lower in patients than in controls (p < 0.001), and 47% of the patients demonstrated E:E < 0.8, including 8% with normal E. In median follow-up of 2.2 (0.8-4.6) years, 53 died, 37 received cardiac transplantation, and 33 received a left ventricular assist device. By multivariable analysis, E (hazard ratios [HR]: 2.01, 95% CI 1.18-3.41) and E:E (HR: 0.46, 95% CI: 0.26-0.82) were independently associated with mortality, whereas E was not.
Right ventricular-pulmonary vascular coupling is frequently impaired in heart failure and associated with greater mortality. Elevated pulmonary arterial elastance is associated with greater mortality even when coupling is preserved.
本研究旨在描述晚期心力衰竭患者的右心室-肺动脉弹性偶联血流动力学表型及其频率，并评估基于弹性的指标与全因死亡率、心脏移植和左心室辅助装置治疗的相关性。
本研究纳入了 175 名接受右心导管检查以评估接受先进治疗的心力衰竭患者和 21 名健康对照者。我们对单拍弹性方法进行了修改，以考虑肺动脉压力的幅度，并估计右心室收缩末期弹性（E）、肺动脉弹性（E）和 E:E 比值。我们将升高的肺动脉负荷定义为 E > 0.5 毫米汞柱/毫升，将心室-动脉解耦定义为 E:E < 0.8。我们使用多变量 Cox 比例风险模型评估了 E、E 和 E:E 与全因死亡率和复合无事件生存率之间的关系，调整了年龄和性别因素。
所有 21 名对照者的 E 值均≤0.5 毫米汞柱/毫升，E:E 值均≥0.8。175 名心力衰竭患者中，63%的患者 E 值>0.5 毫米汞柱/毫升。E:E 值在患者中低于对照组（p<0.001），其中 47%的患者 E:E 值<0.8，包括 8%的患者 E 值正常。在中位数为 2.2（0.8-4.6）年的随访中，53 人死亡，37 人接受心脏移植，33 人接受左心室辅助装置治疗。多变量分析显示，E（风险比[HR]：2.01，95%置信区间[CI]：1.18-3.41）和 E:E（HR：0.46，95%CI：0.26-0.82）与死亡率独立相关，而 E 则不然。
心力衰竭患者的右心室-肺血管偶联常受损，并与更高的死亡率相关。即使偶联得到维持，升高的肺动脉弹性也与更高的死亡率相关。
