Amsallem Myriam, Bagherzadeh Shadi P, Boulate David, Sweatt Andrew J, Kudelko Kristina T, Sung Yon K, Feinstein Jeffrey A, Fadel Elie, Mercier Olaf, Denault Andre, Haddad Francois, Zamanian Roham
Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
Pulm Circ. 2020 Dec 6;10(4):2045894020941343. doi: 10.1177/2045894020941343. eCollection 2020 Oct-Dec.
The relative pulmonary to systemic pressure ratio (mean pulmonary arterial pressure/mean arterial pressure) has been proven to be valuable in cardiac surgery. Little is known on the prognostic value of baseline and trajectory of mean pulmonary arterial pressure/mean arterial pressure in pulmonary arterial hypertension. Patients with confirmed idiopathic, familial, drug and toxins, or connective tissue disease-related pulmonary arterial hypertension and at least one complete right heart catheterization were included and prospectively followed-up for 5.9 ± 4.03 years. Correlates of the primary end point (i.e. death or lung transplant need) during follow-up were determined using Cox regression modeling. Results showed that among the 308 patients included, 187 had at least one follow-up catheterization (median time between catheterizations: 2.16 (1.16-3.19) years). In the total cohort (mean age 47.3 ± 14.9 years, 82.8% of female and 58.1% in New York Heart Association class 3 or 4), mean pulmonary arterial pressure/mean arterial pressure (1.38 (1.07-1.77)) was associated with outcome ( = 0.01). Mean pulmonary arterial pressure/mean arterial pressure was incremental to a basic model (including right atrial pressure, systolic blood pressure, New York Heart Association class 3 or 4, and connective tissue disease) for outcome prediction, while mean pulmonary arterial pressure was not. In the 187 patients with a follow-up catheterization, both delta mean pulmonary arterial pressure and delta mean pulmonary arterial pressure/mean arterial pressure were associated with outcome (1.32 (1.11-1.58) and 1.31 (1.1-1.57) respectively, < 0.01). Mean pulmonary arterial pressure and mean pulmonary arterial pressure/mean arterial pressure were both incremental to the basic model, while worsening in mean pulmonary arterial pressure or mean pulmonary arterial pressure/mean arterial pressure did not reach significance. In conclusion, mean pulmonary arterial pressure/mean arterial pressure at baseline prognosticates long-term outcome with a significant, albeit modest, incremental value to basic variables.
相对肺循环与体循环压力比值（平均肺动脉压/平均动脉压）已被证实在心脏手术中具有重要价值。关于肺动脉高压患者基线及平均肺动脉压/平均动脉压变化轨迹的预后价值，目前所知甚少。纳入确诊为特发性、家族性、药物和毒素相关性或结缔组织病相关性肺动脉高压且至少有一次完整右心导管检查的患者，并对其进行前瞻性随访5.9±4.03年。使用Cox回归模型确定随访期间主要终点（即死亡或需要肺移植）的相关因素。结果显示，在纳入的308例患者中，187例至少进行了一次随访导管检查（两次导管检查之间的中位时间：2.16（1.16 - 3.19）年）。在整个队列中（平均年龄47.3±14.9岁，82.8%为女性，58.1%为纽约心脏协会3或4级），平均肺动脉压/平均动脉压（1.38（1.07 - 1.77））与预后相关（P = 0.01）。平均肺动脉压/平均动脉压对用于预后预测的基础模型（包括右心房压、收缩压、纽约心脏协会3或4级以及结缔组织病）具有增量价值，而平均肺动脉压则不然。在187例进行了随访导管检查的患者中，平均肺动脉压变化值和平均肺动脉压/平均动脉压变化值均与预后相关（分别为1.32（1.11 - 1.58）和1.31（1.1 - 1.57），P < 0.01）。平均肺动脉压和平均肺动脉压/平均动脉压对基础模型均具有增量价值，而平均肺动脉压或平均肺动脉压/平均动脉压的恶化情况未达到显著水平。总之，基线时的平均肺动脉压/平均动脉压可预测长期预后，尽管其增量价值不大，但对基础变量具有显著意义。
