Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Can J Cardiol. 2020 Sep;36(9):1491-1498. doi: 10.1016/j.cjca.2019.10.040. Epub 2019 Nov 11.
Elevated pulmonary artery wedge pressure (PAWP) is the hallmark of left-heart failure and is responsible for heart failure symptoms and mortality. Although PAWP typically correlates with right atrial pressure (RAP), it is primarily dependent on left-heart myocardial properties and volume status. As right-heart disease can occur in the absence of left-heart disease in patients with tetralogy of Fallot (TOF), we hypothesized that RAP was the primary determinant of PAWP in this population.
A cohort study of adults with TOF that underwent right-heart catheterization at Mayo Clinic Rochester (1990 to 2017) to determine the relationship among RAP, PAWP, and mortality.
Among 213 patients (male 105; age 37 ± 14 years), the mean PAWP was 14 ± 5 mm Hg, and RAP was 11 ± 5 mm Hg. RAP was the strongest predictor of PAWP (β = 0.68, standard error = 0.06, P < 0.001), independent of left-heart disease and atherosclerotic cardiovascular risk factors. The patients with high PAWP also had normal tissue Doppler velocities, suggesting normal left-ventricular myocardial properties. PAWP was an independent predictor of death/transplant (hazard ration [HR] 1.11, 95% confidence interval [CI], 1.03-1.20, P = 0.004). However, when RAP was incorporated into the regression model, RAP (and not PAWP) became the independent predictor of outcomes (HR 1.14, 95% CI, 1.06-1.22, P = 0.001).
The current study showed that RAP was the primary determinant of PAWP and accounts, to some extent, for the mortality in patients with TOF and high PAWP. The data provide new insight in the pathophysiology of disease progression for symptomatic patients with TOF.
肺动脉楔压（PAWP）升高是左心衰竭的标志，与心力衰竭症状和死亡率有关。尽管 PAWP 通常与右心房压（RAP）相关，但它主要取决于左心心肌特性和容量状态。由于在法洛四联症（TOF）患者中，即使没有左心疾病也可能发生右心疾病，我们假设在该人群中 RAP 是 PAWP 的主要决定因素。
这是一项在梅奥诊所罗切斯特院区进行的 TOF 成人患者的队列研究，这些患者接受了右心导管检查（1990 年至 2017 年），以确定 RAP、PAWP 和死亡率之间的关系。
在 213 名患者（男性 105 名；年龄 37 ± 14 岁）中，平均 PAWP 为 14 ± 5mmHg，RAP 为 11 ± 5mmHg。RAP 是 PAWP 的最强预测因子（β=0.68，标准误差=0.06，P<0.001），独立于左心疾病和动脉粥样硬化心血管危险因素。PAWP 升高的患者也有正常的组织多普勒速度，提示左心室心肌特性正常。PAWP 是死亡/移植的独立预测因子（危险比[HR]1.11，95%置信区间[CI]1.03-1.20，P=0.004）。然而，当将 RAP 纳入回归模型时，RAP（而非 PAWP）成为结局的独立预测因子（HR 1.14，95%CI，1.06-1.22，P=0.001）。
本研究表明，RAP 是 PAWP 的主要决定因素，并在一定程度上解释了 TOF 患者和高 PAWP 患者的死亡率。这些数据为有症状的 TOF 患者的疾病进展的病理生理学提供了新的见解。
