Zhong Xiujun, Tang Jie, Jiang Rong, Yuan Ping, Zhao Qinhua, Gong Sugang, Liu Jinming, Wang Lan
Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Ann Transl Med. 2021 Feb;9(4):351. doi: 10.21037/atm-21-366.
The aim of the present study was to investigate the role of key cardiopulmonary exercise testing (CPET) parameters in the identification of pre-capillary components in patients with pulmonary hypertension associated with left heart disease (PH-LHD), and to evaluate their correlations with hemodynamic parameters.
Ninety patients with PH-LHD underwent right-heart catheterization, echocardiography, and CPET. The differences in related indexes between a combined post- and pre-capillary PH (Cpc-PH) group (n=47) and an isolated post-capillary PH (Ipc-PH) group (n=43) were compared. Correlation analysis was performed. Logistic regression and receiver operator characteristic (ROC) analyses were performed to assess the ability of CPET variables to distinguish patients with Cpc-PH from those with Ipc-PH.
The hemodynamics, hyperventilation and right ventricular function of Cpc-pH group were worse than those of Ipc-pH group. The parameters related to minute ventilation versus carbon dioxide production (VE/VCO) played a significant role in the differentiation of Cpc-PH and Ipc-PH, and had a moderate positive correlation with pulmonary vascular resistance (PVR). Univariate and multivariate logistic analyses showed that lowest percentage of VE/VCO in predicted value (VE/VCO%pred) was the single best predictor of Cpc-PH, and the area under ROC curve also confirmed that lowest VE/VCO%pred (≥137%) could serve as a novel diagnostic marker for Cpc-PH. On the basis of this lowest VE/VCO%pred threshold, patients were divided into two groups. Most hemodynamic parameters were worse in patients with a lowest VE/VCO%pred ≥137%.
VE/VCO-related parameters are powerful prognosticators for the presence of pre-capillary components in patients with PH-LHD, especially lowest VE/VCO%pred.
本研究旨在探讨关键心肺运动试验（CPET）参数在识别左心疾病相关肺动脉高压（PH-LHD）患者毛细血管前成分中的作用，并评估其与血流动力学参数的相关性。
90例PH-LHD患者接受了右心导管检查、超声心动图检查和CPET。比较了合并毛细血管后和毛细血管前肺动脉高压（Cpc-PH）组（n = 47）和单纯毛细血管后肺动脉高压（Ipc-PH）组（n = 43）之间相关指标的差异。进行了相关性分析。进行逻辑回归和受试者工作特征（ROC）分析，以评估CPET变量区分Cpc-PH患者和Ipc-PH患者的能力。
Cpc-pH组的血流动力学、过度通气和右心室功能比Ipc-pH组差。与分钟通气量与二氧化碳产生量比值（VE/VCO）相关的参数在区分Cpc-PH和Ipc-PH中起重要作用，并且与肺血管阻力（PVR）呈中度正相关。单因素和多因素逻辑分析表明，预测值中VE/VCO的最低百分比（VE/VCO%pred）是Cpc-PH的最佳单一预测指标，ROC曲线下面积也证实最低VE/VCO%pred（≥137%）可作为Cpc-PH的新型诊断标志物。基于此最低VE/VCO%pred阈值，将患者分为两组。最低VE/VCO%pred≥137%的患者大多数血流动力学参数较差。
与VE/VCO相关的参数是PH-LHD患者毛细血管前成分存在的有力预后指标，尤其是最低VE/VCO%pred。
