Department of Cardiology Center for Diagnosis and Management of Pulmonary Vascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Information Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2021 Apr 6;10(7):e018374. doi: 10.1161/JAHA.120.018374. Epub 2021 Mar 23.
Background Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure (PAP) ≥25 mm Hg measured by right heart catheterization. However, the upper limit of a normal mean PAP is 20 mm Hg. There is a gap between the upper limit of normal and the threshold for diagnosing PH. Therefore, we aimed to investigate whether individuals with a mildly elevated PAP, defined as 20 mm Hg < mean PAP <25 mm Hg, are at an increased risk of progression to PH or mortality than those with a normal PAP. Methods and Results We reviewed studies evaluating the risk of progression to PH and/or mortality in individuals with a mildly elevated PAP versus those with a normal PAP. The mean PAP value of each participant was confirmed by right heart catheterization. We reviewed 1213 studies and 8 fulfilled our inclusion criteria. Our results indicated that individuals with a mildly elevated PAP were 1.81 to 2.45 times more likely to progress to PH than individuals with a normal PAP. There was a statistically significant difference in mortality between the mildly elevated PAP and normal PAP groups (hazard ratio, 2.48; 95% CI, 1.69-3.64). We also pooled survival probabilities in each arm to obtain a summary survival curve for each group, and the pooled survival rates in the mildly elevated PAP group were numerically lower than those in the normal PAP group. Conclusions Our study revealed that individuals with a mildly elevated PAP were at an increased risk of progression to PH and mortality than those with a normal PAP.
背景 肺动脉高压（PH）定义为右心导管测量的平均肺动脉压（PAP）≥25mmHg。然而，正常平均 PAP 的上限为 20mmHg。正常上限和诊断 PH 的阈值之间存在差距。因此，我们旨在研究 PAP 轻度升高（定义为 20mmHg＜平均 PAP＜25mmHg）的个体与 PAP 正常的个体相比，进展为 PH 或死亡的风险是否增加。
方法和结果 我们回顾了评估 PAP 轻度升高个体与 PAP 正常个体进展为 PH 和/或死亡风险的研究。每个参与者的平均 PAP 值均通过右心导管检查确认。我们共审查了 1213 项研究，其中 8 项符合我们的纳入标准。我们的结果表明，PAP 轻度升高的个体进展为 PH 的可能性是 PAP 正常个体的 1.81 至 2.45 倍。PAP 轻度升高组与 PAP 正常组之间的死亡率存在统计学差异（危险比，2.48；95%置信区间，1.69-3.64）。我们还对每个臂的生存概率进行了汇总，以获得每个组的汇总生存曲线，并且 PAP 轻度升高组的汇总生存率在数值上低于 PAP 正常组。
结论 我们的研究表明，与 PAP 正常的个体相比，PAP 轻度升高的个体进展为 PH 和死亡的风险增加。
