Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Can J Cardiol. 2021 Jan;37(1):131-139. doi: 10.1016/j.cjca.2020.02.084. Epub 2020 Feb 26.
Pulmonary artery wedge pressure (PAWP) is often elevated in patients with right-sided congenital heart disease (CHD), raising the possibility of coexisting left-heart disease, but pressure-volume relationships in the left and right sides of the heart influence one another through interdependence, which may be amplified in patients with CHD.
We hypothesized that increases in PAWP in patients with CHD would be more strongly related to ventricular interdependence compared with patients who have isolated left-heart disease such as heart failure with preserved ejection fraction (HFpEF). Ventricular interdependence was assessed by the relationship between PAWP and right-atrial pressure (RAP), RAP/PAWP ratio, and the left-ventricular (LV) eccentricity index.
PAWP was elevated (≥15 mm Hg) in 49% of patients with CHD (n = 449). There was a very strong correlation between RAP and PAWP in CHD (r = 0.81, P < 0.001) that greatly exceeded the respective correlation in HFpEF (n = 160; r = 0.58, P < 0.001; P < 0.001 between groups). RAP/PAWP ratio and LV eccentricity index were higher in CHD than HFpEF (1.26 ± 0.18 vs 1.05 ± 0.14, P = 0.007) and (0.80 ± 0.21 vs 0.59 ± 0.19, P < 0.001), respectively. RAP (but not PAWP) was an independent predictor of death/transplant (hazard ratio 1.86 per 5 mm Hg, 95% confidence interval, 1.39-2.45, P = 0.002).
Left-heart filling pressures are commonly elevated in right-sided CHD, but this is related predominantly to right-heart failure and enhanced ventricular interdependence rather than left-heart disease. These data provide new insight into the basis of abnormal left-heart hemodynamics in patients with CHD and reinforce the importance of therapeutic interventions targeted to the right heart.
在患有右心先天性心脏病（CHD）的患者中，肺动脉楔压（PAWP）通常升高，这增加了合并左心疾病的可能性，但左右心之间的压力-容积关系通过相互依存而相互影响，这种相互影响在 CHD 患者中可能会被放大。
我们假设 CHD 患者的 PAWP 升高与心室相互依赖的关系比孤立性左心疾病（如射血分数保留的心衰，HFpEF）患者更为密切。心室相互依赖通过 PAWP 与右心房压（RAP）、RAP/PAWP 比值和左心室（LV）偏心指数之间的关系来评估。
49%的 CHD 患者（n=449）PAWP 升高（≥15mmHg）。CHD 患者的 RAP 与 PAWP 之间存在很强的相关性（r=0.81，P<0.001），这大大超过了 HFpEF 患者的相关性（n=160；r=0.58，P<0.001；P<0.001 组间比较）。CHD 患者的 RAP/PAWP 比值和 LV 偏心指数均高于 HFpEF（1.26±0.18 比 1.05±0.14，P=0.007；0.80±0.21 比 0.59±0.19，P<0.001）。RAP（而非 PAWP）是死亡/移植的独立预测因子（每 5mmHg 风险比 1.86，95%置信区间 1.39-2.45，P=0.002）。
在右心 CHD 患者中，左心充盈压通常升高，但这主要与右心衰竭和增强的心室相互依赖有关，而不是左心疾病。这些数据为 CHD 患者异常左心血流动力学的基础提供了新的见解，并强调了针对右心的治疗干预的重要性。
