Chemla Denis, Berthelot Emmanuelle, Weatherald Jason, Lau Edmund M T, Savale Laurent, Beurnier Antoine, Montani David, Sitbon Olivier, Attal Pierre, Boulate David, Assayag Patrick, Humbert Marc, Hervé Philippe
Service d'explorations fonctionnelles multidisciplinaires bi-site Antoine Béclère - Kremlin Bicêtre, GHU Paris Sud, DMU-CORREVE, AP-HP, Le Kremlin-Bicêtre, France.
Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
ERJ Open Res. 2021 May 31;7(2). doi: 10.1183/23120541.00941-2020. eCollection 2021 Apr.
Pulmonary hypertension is associated with stiffening of pulmonary arteries which increases right ventricular pulsatile loading. High pulmonary artery wedge pressure (PAWP) in postcapillary pulmonary hypertension (Pc-PH) further decreases pulmonary arterial compliance (PAC) at a given pulmonary vascular resistance (PVR) compared with precapillary pulmonary hypertension, thus responsible for a higher total arterial load. In all other vascular beds, arterial compliance is considered as mainly determined by the distending pressure, due to non-linear stress-strain behaviour of arteries. We tested the applicability, advantages and drawbacks of two comparison methods of PAC depending on the level of mean pulmonary arterial pressure (mPAP; isobaric PAC) or PVR. Right heart catheterisation data including PAC (stroke volume/pulse pressure) were obtained in 112 Pc-PH (of whom 61 had combined postcapillary and precapillary pulmonary hypertension) and 719 idiopathic pulmonary arterial hypertension (iPAH). PAC could be compared over the same mPAP range (25-66 mmHg) in 792 (95.3%) out of 831 patients and over the same PVR range (3-10.7 WU) in only 520 (62.6%) out of 831 patients. The main assumption underlying comparisons at a given PVR was not verified as the PVR×PAC product (RC-time) was not constant but on the contrary more variable than mPAP. In the 788/831 (94.8%) patients studied over the same PAC range (0.62-6.5 mL·mmHg), PVR and thus total arterial load tended to be higher in iPAH. Our study favours comparing PAC at fixed mPAP level (isobaric PAC) rather than at fixed PVR. A reappraisal of the effects of PAWP on the pulsatile and total arterial load put on the right heart is needed, and this point deserves further studies.
肺动脉高压与肺动脉僵硬度增加相关，这会增加右心室的搏动负荷。与毛细血管前性肺动脉高压相比，毛细血管后性肺动脉高压（Pc-PH）中较高的肺动脉楔压（PAWP）在给定的肺血管阻力（PVR）下会进一步降低肺动脉顺应性（PAC），从而导致更高的总动脉负荷。在所有其他血管床中，由于动脉的非线性应力-应变行为，动脉顺应性主要被认为由扩张压力决定。我们测试了两种根据平均肺动脉压（mPAP；等压PAC）或PVR水平比较PAC的方法的适用性、优点和缺点。在112例Pc-PH患者（其中61例合并毛细血管后性和毛细血管前性肺动脉高压）和719例特发性肺动脉高压（iPAH）患者中获得了包括PAC（每搏量/脉压）的右心导管检查数据。831例患者中有792例（95.3%）可在相同的mPAP范围（25-66 mmHg）内比较PAC，而在相同的PVR范围（3-10.7 WU）内只有520例（62.6%）患者可进行比较。在给定PVR下进行比较的主要假设未得到验证，因为PVR×PAC乘积（RC时间）并非恒定，相反，其比mPAP更具变异性。在788/831例（94.8%）在相同PAC范围（0.62-6.5 mL·mmHg）内研究的患者中，iPAH患者中的PVR以及因此的总动脉负荷往往更高。我们的研究倾向于在固定的mPAP水平（等压PAC）而非固定的PVR下比较PAC。需要重新评估PAWP对右心搏动和总动脉负荷的影响，这一点值得进一步研究。
