Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA.
Stanford Cardiovascular Institute Stanford University School of Medicine Stanford CA.
J Am Heart Assoc. 2020 Jun 2;9(11):e016265. doi: 10.1161/JAHA.119.016265. Epub 2020 May 16.
Background The strong linear relation between mean (MPAP) and systolic (SPAP) pulmonary arterial pressure (eg, SPAP=1.62×MPAP) has been mainly reported in precapillary pulmonary hypertension. This study sought to quantify the influence of pulmonary arterial wedge pressure (PAWP), heart rate, and age on the MPAP-SPAP relation. Methods and Results An allometric equation relating invasive MPAP and SPAP was developed in 1135 patients with pulmonary arterial hypertension, advanced lung disease, chronic thromboembolic pulmonary hypertension, or left heart failure. The equation was validated in 60 885 patients from the United Network for Organ Sharing (UNOS) database referred for heart and/or lung transplant. The MPAP/SPAP longitudinal stability was assessed in pulmonary arterial hypertension with repeated right heart catheterization. The equation obtained was SPAP=1.39×MPAP×PAWP×(60/heart rate)×age (<0.001). It was validated in the UNOS cohort (=0.93, <0.001), regardless of the type of organ(s) patients were listed for (mean bias [-1.96 SD; 1.96 SD] was 0.94 [-8.00; 9.88] for heart, 1.34 [-7.81; 10.49] for lung and 0.25 [-16.74; 17.24] mm Hg for heart-lung recipients). Thresholds of SPAP for MPAP=25 and 20 mm Hg were lower in patients with higher PAWP (37.2 and 29.8 mm Hg) than in those with pulmonary arterial hypertension (40.1 and 32.0 mm Hg). In 186 patients with pulmonary arterial hypertension, the predicted MPAP/SPAP was stable over time (0.63±0.03 at baseline and follow-up catheterization, =0.43). Conclusions This study quantifies the impact of PAWP, and to a lesser extent heart rate and age, on the MPAP-SPAP relation, supporting lower SPAP thresholds for pulmonary hypertension diagnosis in patients with higher PAWP for echocardiography-based epidemiological studies.
平均肺动脉压（MPAP）和收缩期肺动脉压（SPAP）之间的强线性关系主要在毛细血管前肺动脉高压中报道。本研究旨在量化肺动脉楔压（PAWP）、心率和年龄对 MPAP-SPAP 关系的影响。
在肺动脉高压、晚期肺病、慢性血栓栓塞性肺动脉高压或左心衰竭患者中，开发了一种将有创性 MPAP 和 SPAP 相关联的比例方程。该方程在来自美国器官共享网络（UNOS）数据库的 60885 名接受心脏和/或肺移植的患者中进行了验证。通过对肺动脉高压患者进行重复右心导管检查评估了 MPAP/SPAP 的纵向稳定性。获得的方程为 SPAP=1.39×MPAP×PAWP×（60/心率）×年龄（<0.001）。该方程在 UNOS 队列中得到验证（=0.93，<0.001），无论患者列出的器官类型如何（平均偏差[-1.96 SD；1.96 SD]为心脏 0.94[-8.00；9.88]、肺 1.34[-7.81；10.49]和心肺受体 0.25[-16.74；17.24]mmHg）。PAWP 较高的患者的 SPAP 为 MPAP=25 和 20 mmHg 的阈值低于肺动脉高压患者（37.2 和 29.8 mmHg）（40.1 和 32.0 mmHg）。在 186 例肺动脉高压患者中，预测的 MPAP/SPAP 在时间上是稳定的（基线和随访导管检查时为 0.63±0.03，=0.43）。
本研究量化了 PAWP，以及在较小程度上心率和年龄，对 MPAP-SPAP 关系的影响，支持在基于超声心动图的流行病学研究中，PAWP 较高的患者的肺动脉高压诊断中使用较低的 SPAP 阈值。
