Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
Chest. 2021 Feb;159(2):781-790. doi: 10.1016/j.chest.2020.08.2110. Epub 2020 Sep 12.
Pulmonary hemodynamics during exercise may reveal early pulmonary vascular disease and may be of clinical and prognostic relevance in systemic sclerosis (SSc). We aimed to assess the prognostic relevance of exercise pulmonary resistances in patients with SSc with no or mildly increased mean pulmonary arterial pressure (mPAP).
Are pulmonary resistances at peak exercise independent predictors of mortality in systemic sclerosis?
All SSc patients with resting mPAP < 25 mm Hg and at least one year of follow-up data who underwent symptom-limited exercise right heart catheterization between April 2005 and December 2018 were analyzed retrospectively. Age-adjusted Cox regression analysis was used to evaluate the association between pulmonary resistances and all-cause mortality.
The cohort consisted of 80 patients: 73 women and 7 men with a mean age of 57 years (interquartile range [IQR], 47-67 years) and a mean follow-up time of 10.4 years (IQR, 8.5-11.8 years). At baseline, resting mPAP of ≤ 20 mm Hg and 21 to 24 mm Hg was found in 68 and 12 patients, respectively. Pulmonary vascular resistance (PVR) and total pulmonary resistance (TPR) at peak exercise were associated significantly with mortality (P = .006 [hazard ratio (HR), 2.20; 95% CI, 1.26-3.87] and P = .026 [HR, 1.56; 95% CI, 1.06-2.29]), whereas resting PVR and TPR were not (P = .087 [HR, 2.27; 95% CI, 0.89-5.83] and P = .079 [HR, 1.88; 95% CI, 0.93-3.80]). The mPAP per cardiac output (CO) and transpulmonary gradient (TPG) per CO slopes were associated significantly with mortality (P = .047 [HR, 1.14; 95% CI, 1.002-1.286] and P = .034 [HR, 1.34; 95% CI, 1.02-1.76]) as well. The area under the receiver operating characteristic curve for exercise PVR to predict 10-year mortality was 0.917 (95% CI, 0.797-1.000).
PVR and TPR at peak exercise, mPAP/CO slope, and TPG/CO slope are predictors of age-adjusted long-term mortality in SSc patients with no or mildly increased pulmonary arterial pressure.
运动时的肺血流动力学可揭示早期肺血管疾病，并且可能与系统性硬化症（SSc）的临床和预后相关。我们旨在评估在平均肺动脉压（mPAP）无或轻度升高的 SSc 患者中，运动时肺阻力的预后相关性。
运动时的肺阻力是否是系统性硬化症患者死亡的独立预测因素？
回顾性分析了 2005 年 4 月至 2018 年 12 月期间接受症状限制右心导管检查的 mPAP<25mmHg 的静止期 SSc 患者，且至少有一年的随访数据。使用年龄调整的 Cox 回归分析评估肺阻力与全因死亡率之间的关系。
队列包括 80 名患者：73 名女性和 7 名男性，平均年龄为 57 岁（四分位距[IQR]，47-67 岁），平均随访时间为 10.4 年（IQR，8.5-11.8 年）。基线时，68 名患者的静息 mPAP≤20mmHg，12 名患者的静息 mPAP 为 21-24mmHg。运动时的肺血管阻力（PVR）和总肺阻力（TPR）与死亡率显著相关（P=0.006[风险比（HR），2.20；95%置信区间[CI]，1.26-3.87]和 P=0.026[HR，1.56；95%CI，1.06-2.29]），而静息时的 PVR 和 TPR 与死亡率无关（P=0.087[HR，2.27；95%CI，0.89-5.83]和 P=0.079[HR，1.88；95%CI，0.93-3.80]）。mPAP/CO 和 TPG/CO 斜率与死亡率显著相关（P=0.047[HR，1.14；95%CI，1.002-1.286]和 P=0.034[HR，1.34；95%CI，1.02-1.76]）。运动时 PVR 预测 10 年死亡率的受试者工作特征曲线下面积为 0.917（95%CI，0.797-1.000）。
运动时的 PVR 和 TPR、mPAP/CO 斜率和 TPG/CO 斜率是平均肺动脉压无或轻度升高的 SSc 患者年龄调整后长期死亡率的预测因素。
