Rubáčková Popelová Jana, Tomek Jakub, Tomková Markéta, Živná Renata
Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czechia.
Pediatric Heart Centre, Motol University Hospital, Prague, Czechia.
Front Cardiovasc Med. 2022 Jun 10;9:876755. doi: 10.3389/fcvm.2022.876755. eCollection 2022.
Pulmonary hypertension (PH) is an established risk factor in patients with atrial septal defect (ASD), and its persistence after ASD closure is associated with increased mortality. Therefore, predictors for PH normalization after defect closure are needed. Multiple hemodynamic types of PH exist, but little is known about their prevalence and prognostic value for PH normalization after ASD closure. We carried out a retrospective study on 97 patients (76% female, median age at ASD closure 58 years) with four types of PH determined predominantly by right heart catheterization: hyperkinetic, pulmonary arterial hypertension, isolated post-capillary, and combined pre- and post-capillary. We investigated the frequency of the PH types and their prognostic significance for PH normalization after ASD closure. Frequency of PH types before ASD closure in our study was: hyperkinetic 55%, pulmonary arterial hypertension 10%, isolated post-capillary PH 24%, and combined PH 11%. Hyperkinetic PH type was positively associated with PH normalization after ASD closure (78% patients normalized), remaining a significant independent predictor when adjusted for age at closure, sex, heart failure, and NYHA. Hyperkinetic PH patients also had significantly better survival prognosis versus patients with other PH types ( = 0.04). Combined PH was negatively associated with PH normalization, with no patients normalizing. Pulmonary arterial hypertension and isolated post-capillary PH had intermediate rates of normalization (60 and 52%, respectively). In summary, all four hemodynamic types of PH are found in adult patients with ASD, and they can be used to stratify patients by their likelihood of PH normalization and survival after ASD closure.
肺动脉高压（PH）是房间隔缺损（ASD）患者的一个既定危险因素，ASD封堵术后其持续存在与死亡率增加相关。因此，需要了解缺损封堵术后PH恢复正常的预测因素。存在多种血流动力学类型的PH，但对于它们在ASD封堵术后PH恢复正常方面的患病率和预后价值知之甚少。我们对97例患者（76%为女性，ASD封堵时的中位年龄为58岁）进行了一项回顾性研究，这些患者主要通过右心导管检查确定有四种类型的PH：高动力型、肺动脉高压型、单纯毛细血管后型和毛细血管前与后混合型。我们调查了这些PH类型的频率及其对ASD封堵术后PH恢复正常的预后意义。在我们的研究中，ASD封堵术前PH类型的频率为：高动力型55%，肺动脉高压型10%，单纯毛细血管后型PH 24%，混合型PH 11%。高动力型PH与ASD封堵术后PH恢复正常呈正相关（78%的患者恢复正常），在调整了封堵时的年龄、性别、心力衰竭和纽约心脏协会（NYHA）分级后，仍然是一个显著的独立预测因素。与其他PH类型的患者相比，高动力型PH患者的生存预后也显著更好（P = 0.04）。混合型PH与PH恢复正常呈负相关，没有患者恢复正常。肺动脉高压型和单纯毛细血管后型PH的恢复正常率处于中等水平（分别为60%和52%）。总之，在成年ASD患者中发现了所有四种血流动力学类型的PH，它们可用于根据ASD封堵术后PH恢复正常的可能性和生存情况对患者进行分层。
