Liu Yi-Xian, Li Hui, Xia Yi-Yuan, Xia Chun-Lei, Qu Xin-Liang, Chu Peng, Zhou Wen-Yin, Zhu Lin-Lin, Li Li, Chen Shao-Liang, Zhang Jun-Xia
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Laboratory of Cardiovascular Diseases, Nanjing Heart Centre, Nanjing, China.
J Geriatr Cardiol. 2020 Jul 28;17(7):400-409. doi: 10.11909/j.issn.1671-5411.2020.07.002.
The determinants of pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF) have been poorly investigated in patients with cardiovascular diseases (CVD).
From July 1 2017 to March 31 2019, a total of 149 consecutive HFpEF patients hospitalized with CVD were enrolled in this prospective cross-sectional study. A systolic pulmonary artery pressure (PASP) > 35 mmHg estimated by echocardiography was defined as PH-HFpEF. Logistic regression was performed to establish predictors of PH in HFpEF patients.
Overall, the mean age of participants was 72 ± 11 years, and 74 (49.7%) patients were females. A total of 59 (39.6%) patients were diagnosed with PH-HFpEF by echocardiography. The left atrial diameter (LAD) was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole (E/E') and the left ventricular diameter in systole (LVDs). N-Terminal pro B-type natriuretic peptide (NT-proBNP) was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle. Multivariable logistic regression showed that atrial fibrillation (AF) increased the risk of PH-HFpEF incidence 3.46-fold with a 95% confidence interval (CI) of 1.44-8.32, = 0.005. Meanwhile, LAD ≥ 45 mm resulted in a 3.43-fold increased risk, 95% CI: 1.51-7.75, = 0.003. However, the significance levels of NT-proBNP, age and LVEF were underpowered in the regression model. Two variables, AF and LAD ≥ 45 mm, predicted the PH-HFpEF incidence (C-statistic = 0.773, 95% CI: 0.695-0.852, < 0.001).
Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.
射血分数保留的心力衰竭（HFpEF）所致肺动脉高压（PH）的决定因素在心血管疾病（CVD）患者中尚未得到充分研究。
2017年7月1日至2019年3月31日，本前瞻性横断面研究共纳入149例因CVD住院的连续性HFpEF患者。经超声心动图估计收缩期肺动脉压（PASP）>35 mmHg定义为PH-HFpEF。采用逻辑回归分析确定HFpEF患者中PH的预测因素。
总体而言，参与者的平均年龄为72±11岁，74例（49.7%）为女性。共有59例（39.6%）患者经超声心动图诊断为PH-HFpEF。左心房直径（LAD）与舒张早期二尖瓣血流速度/二尖瓣环组织速度比值（E/E'）及收缩期左心室直径（LVDs）相关。未发现N末端B型利钠肽原（NT-proBNP）与LAD及左心室舒张或收缩功能受损相关。多变量逻辑回归显示，心房颤动（AF）使PH-HFpEF发生风险增加3.46倍，95%置信区间（CI）为1.44-8.32，P=0.005。同时，LAD≥45 mm使风险增加3.43倍，95%CI：1.51-7.75，P=0.003。然而，NT-proBNP、年龄和左心室射血分数（LVEF）在回归模型中的显著性水平不足。AF和LAD≥45 mm这两个变量可预测PH-HFpEF的发生（C统计量=0.773，95%CI：0.695-0.852，P<0.001）。
与左心房电重构和解剖重构相关的两个参数与CVD合并HFpEF患者的PH发生率相关。
