Yang Jeong Hoon, Harada Tomonari, Choi Ki Hong, Kato Toshimitsu, Kim Darae, Takama Noriaki, Park Taek Kyu, Kurabayashi Masahiko, Chang Sung-A, Obokata Masaru
Department of Critical Care Medicine (J.H.Y.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Cardiology, Heart Vascular Stroke Institute (J.H.Y., K.H.C., D.K., T.K.P., S.-A.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Circ Heart Fail. 2022 Mar;15(3):e009028. doi: 10.1161/CIRCHEARTFAILURE.121.009028. Epub 2022 Feb 22.
Identification of elevated pulmonary artery (PA) pressures during exercise may provide diagnostic, prognostic, and therapeutic implications in heart failure with preserved ejection fraction. Although widely performed, exercise stress echocardiography may underestimate true PA pressures due to the difficulty in estimating right atrial pressure (RAP) during exercise. We hypothesized that peripheral venous pressure (PVP) could allow for reliable estimation of RAP, and thus PA pressures during exercise stress echocardiography.
In protocol 1, we investigated the accuracy of PVP compared with simultaneously measured RAP at rest and during exercise right heart catheterization in 19 subjects. In protocol 2, we examined whether the addition of PVP to Doppler exercise echocardiography (tricuspid regurgitant velocity) would increase the ability to identify exercise-induced pulmonary hypertension compared with inferior vena cava-based RAP estimation in 60 patients with dyspnea.
In protocol 1, PVP was strongly correlated with simultaneously measured RAP at rest and during exercise (=0.77 and 0.90), with little overestimation of invasively measured RAP (bias 3.4 mm Hg at rest and 1.7 mm Hg during exercise). In protocol 2, PVP increased dramatically during exercise echocardiography (14±5 mm Hg) while an increase in inferior vena cava-based RAP was modest (6±4 mm Hg). Exercise PA pressures calculated from PVP and tricuspid regurgitant velocity were significantly higher than those estimated from inferior vena cava and the use of PVP increased the proportion of patients with exercise-induced pulmonary hypertension from 40% to 68%.
PVP may prevent underestimation of PA pressures during exercise echocardiography and could be a preferred approach to identify exercise-induced pulmonary hypertension in patients with suspected heart failure with preserved ejection fraction.
运动期间肺动脉（PA）压力升高的识别可能为射血分数保留的心力衰竭提供诊断、预后及治疗方面的指导。尽管运动负荷超声心动图应用广泛，但由于运动期间右心房压力（RAP）难以估计，可能会低估真实的PA压力。我们推测外周静脉压（PVP）可用于可靠估计RAP，进而在运动负荷超声心动图期间估计PA压力。
在方案1中，我们研究了19名受试者在静息和运动右心导管检查时，PVP与同时测量的RAP相比的准确性。在方案2中，我们检查了在60例呼吸困难患者中，与基于下腔静脉的RAP估计相比，在多普勒运动超声心动图（三尖瓣反流速度）中加入PVP是否会提高识别运动诱发肺动脉高压的能力。
在方案1中，PVP与静息和运动时同时测量的RAP密切相关（分别为0.77和0.90），对有创测量的RAP几乎没有高估（静息时偏差3.4 mmHg，运动时偏差1.7 mmHg）。在方案2中，运动超声心动图期间PVP显著升高（14±5 mmHg），而基于下腔静脉的RAP升高幅度较小（6±4 mmHg）。根据PVP和三尖瓣反流速度计算的运动PA压力显著高于根据下腔静脉估计的压力，并且使用PVP使运动诱发肺动脉高压患者的比例从40%增加到68%。
PVP可防止运动超声心动图期间PA压力的低估，并且可能是识别疑似射血分数保留心力衰竭患者运动诱发肺动脉高压的首选方法。
