Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
Echocardiography. 2021 Aug;38(8):1297-1306. doi: 10.1111/echo.15141. Epub 2021 Jun 29.
Identification of elevation in pulmonary pressures during exercise may provide prognostic and therapeutic implications in patients with connective tissue disease (CTD). Interstitial lung disease (ILD) is common in CTD patients and subtle interstitial abnormalities detected by lung ultrasound could predict exercise-induced pulmonary hypertension (PH).
Echocardiography and lung ultrasound were performed at rest and bicycle exercise in CTD patients (n = 41) and control subjects without CTD (n = 24). Ultrasound B-lines were quantified by scanning four intercostal spaces in the right hemithorax. We examined the association between total B-lines at rest and the development of exercise-induced PH during ergometry exercise. Compared to controls, the number of total B-lines at rest was higher in CTD patients (0 [0, 0] vs 2 [0, 9], P < .0001) and was correlated with radiological severity of ILD assessed by computed tomography (fibrosis score, r = .70, P < .0001). Pulmonary artery systolic pressure (PASP) was increased with ergometry exercise in CTD compared to controls (48 ± 14 vs 35 ± 13 mm Hg, P = .0006). The number of total B-lines at rest was highly correlated with higher PASP (r = .52, P < .0001) and poor right ventricular pulmonary artery coupling (tricuspid annular plane systolic excursion/PASP ratio, r = -.31, P = .01) during peak exercise. The number of resting B-lines predicted the development of exercise-induced PH with an area under the curve .79 (P = .0003).
These data may suggest the value of a simple resting assessment of lung ultrasound as a potential tool for assessing the risk of exercise-induced PH in CTD patients.
在患有结缔组织病（CTD）的患者中，识别运动期间的肺动脉压升高可能具有预后和治疗意义。间质性肺疾病（ILD）在 CTD 患者中很常见，通过肺部超声检测到的细微间质异常可预测运动引起的肺动脉高压（PH）。
对 41 例 CTD 患者和 24 例无 CTD 的对照组患者进行了超声心动图和肺部超声检查，分别在静息和踏车运动时进行。通过扫描右半胸的四个肋间来量化超声 B 线。我们研究了静息时总 B 线与踏车运动时运动诱导 PH 发展之间的相关性。与对照组相比，CTD 患者静息时的总 B 线数量较高（0 [0, 0] 比 2 [0, 9]，P <.0001），且与 CT 评估的ILD 放射学严重程度相关（纤维化评分，r =.70，P <.0001）。与对照组相比，CTD 患者在踏车运动时肺动脉收缩压（PASP）升高（48 ± 14 比 35 ± 13 mm Hg，P =.0006）。静息时总 B 线数量与更高的 PASP（r =.52，P <.0001）和运动峰值时右心室肺动脉耦合不良（三尖瓣环平面收缩期位移/PASP 比值，r = -.31，P =.01）高度相关。静息 B 线数量预测运动诱导 PH 的曲线下面积为.79（P =.0003）。
这些数据可能表明，简单的肺部超声静息评估可能是评估 CTD 患者运动诱导 PH 风险的一种潜在工具。
