Weber Lukas, Rickli Hans, Haager Philipp K, Joerg Lucas, Weilenmann Daniel, Chronis Joannis, Rigger Johannes, Buser Marc, Ehl Niklas F, Maeder Micha T
Cardiology Department, Kantonsspital St. Gallen, CH-9007 St. Gallen, Switzerland.
J Clin Med. 2021 Aug 28;10(17):3878. doi: 10.3390/jcm10173878.
(1) Background: Pulmonary hypertension after aortic valve replacement (AVR; post-AVR PH) carries a poor prognosis. We assessed the pre-AVR hemodynamic characteristics of patients with versus without post-AVR PH. (2) Methods: We studied 205 patients (mean age 75 ± 10 years) with severe AS (indexed aortic valve area 0.42 ± 0.12 cm/m, left ventricular ejection fraction 58 ± 11%) undergoing right heart catheterization (RHC) prior to surgical (70%) or transcatheter (30%) AVR. Echocardiography to assess post-AVR PH, defined as estimated systolic pulmonary artery pressure > 45 mmHg, was performed after a median follow-up of 15 months. (3) Results: There were 83/205 (40%) patients with pre-AVR PH (defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg by RHC), and 24/205 patients (12%) had post-AVR PH (by echocardiography). Among the patients with post-AVR PH, 21/24 (88%) had already had pre-AVR PH. Despite similar indexed aortic valve area, patients with post-AVR PH had higher mPAP, mean pulmonary artery wedge pressure (mPAWP) and pulmonary vascular resistance (PVR), and lower pulmonary artery capacitance (PAC) than patients without. (4) Conclusions: Patients presenting with PH roughly one year post-AVR already had worse hemodynamic profiles in the pre-AVR RHC compared to those without, being characterized by higher mPAP, mPAWP, and PVR, and lower PAC despite similar AS severity.
（1）背景：主动脉瓣置换术后肺动脉高压（AVR后PH）预后较差。我们评估了有或无AVR后PH患者的AVR前血流动力学特征。（2）方法：我们研究了205例严重主动脉瓣狭窄患者（平均年龄75±10岁，主动脉瓣面积指数0.42±0.12 cm/m²，左心室射血分数58±11%），这些患者在接受外科手术（70%）或经导管（30%）AVR之前进行了右心导管检查（RHC）。在中位随访15个月后，进行超声心动图检查以评估AVR后PH，定义为估计收缩期肺动脉压>45 mmHg。（3）结果：有83/205（40%）例患者存在AVR前PH（通过RHC定义为平均肺动脉压（mPAP）≥25 mmHg），24/205例患者（12%）存在AVR后PH（通过超声心动图检查）。在有AVR后PH的患者中，21/24（88%）已经存在AVR前PH。尽管主动脉瓣面积指数相似，但与无AVR后PH的患者相比，有AVR后PH的患者mPAP、平均肺动脉楔压（mPAWP）和肺血管阻力（PVR）更高，肺动脉容量（PAC）更低。（4）结论：与无PH的患者相比，AVR后约一年出现PH的患者在AVR前RHC时血流动力学状况更差，其特征是尽管主动脉瓣狭窄严重程度相似，但mPAP、mPAWP和PVR更高，PAC更低。
