Boxhammer Elke, Mirna Moritz, Bäz Laura, Alushi Brunilda, Franz Marcus, Kretzschmar Daniel, Hoppe Uta C, Lauten Alexander, Lichtenauer Michael
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Universitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, Germany.
J Clin Med. 2022 May 25;11(11):2978. doi: 10.3390/jcm11112978.
Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The aim of the study was to examine the role of differentiated classification basis of PCWP and LVEDP in patients planning for transcatheter aortic valve implantation (TAVI).
284 patients with severe AS completed a combined left (LHC) and right heart catheterization (RHC) as part of a TAVI planning procedure. Patients were categorized twice into subtypes of PH according to 2015 European Society of Cardiology (ESC) guidelines-on the one hand with PCWP and on the other hand with LVEDP as classification basis. PCWP-LVEDP relationships were figured out using Kaplan-Meier curves, linear regressions and Bland-Altman analysis.
Regarding 1-year mortality, Kaplan-Meier analyses showed similar curves in spite of different classification bases of PH subtypes according to PCWP or LVEDP with exception of pre-capillary PH subtype. PCWP-LVEDP association in the overall cohort was barely present (R = 0.210, R = 0.044). When focusing analysis on PH patients only a slightly increased linear regression was noted compared to the overall cohort (R = 0.220, R = 0.048). The strongest regression was observed in patients with creatinine ≥ 132 µmol/L (R = 0.357, R = 0.127) and in patients with mitral regurgitation ≥ II° (R = 0.326, R = 0.106).
In patients with severe AS, there is a weak association between hemodynamic parameters measured by LHC and RHC. RHC measurements alone are not suitable for risk stratification with respect to one-year mortality. If analysis of hemodynamic parameters is necessary in patients with severe AS scheduled for TAVI, measurement results of LHC and RHC should be combined and LVEDP could serve as a helpful indicator for risk assessment.
肺毛细血管楔压（PCWP）和左心室舒张末期压力（LVEDP）常被用作判定肺动脉高压（PH）的等效指标。PH是重度主动脉瓣狭窄（AS）患者的一种合并症，与预后受限相关。本研究的目的是探讨PCWP和LVEDP不同分类依据在计划行经导管主动脉瓣植入术（TAVI）患者中的作用。
284例重度AS患者作为TAVI计划程序的一部分，完成了左心导管检查（LHC）和右心导管检查（RHC）。根据2015年欧洲心脏病学会（ESC）指南，患者被分两次归类为PH亚型——一方面以PCWP为分类依据，另一方面以LVEDP为分类依据。使用Kaplan-Meier曲线、线性回归和Bland-Altman分析来确定PCWP-LVEDP关系。
关于1年死亡率，Kaplan-Meier分析显示，尽管根据PCWP或LVEDP对PH亚型进行了不同的分类，但除毛细血管前PH亚型外，曲线相似。总体队列中PCWP-LVEDP关联几乎不存在（R = 0.210，R = 0.044）。仅对PH患者进行分析时，与总体队列相比，线性回归略有增加（R = 0.220，R = 0.048）。在肌酐≥132 μmol/L的患者（R = 0.357，R = 0.127）和二尖瓣反流≥II°的患者（R = 0.３26，R = 0.106）中观察到最强的回归。
在重度AS患者中，LHC和RHC测量的血流动力学参数之间存在弱关联。仅RHC测量不适合用于1年死亡率的风险分层。如果对计划进行TAVI的重度AS患者有必要分析血流动力学参数，应将LHC和RHC的测量结果结合起来，LVEDP可作为风险评估的有用指标。
