Mekontso Dessap Armand, Hanrott Kate, Powley William M, Fowler Andrew, Bayliffe Andrew, Bagate François, Hall David A, Lazaar Aili L, Budd David C, Vieillard-Baron Antoine
Medical Intensive Care Unit, Henri Mondor Hospital, AP-HP, 94010 Creteil, France.
CARMAS Research Group, UPEC, 94010 Creteil, France.
J Clin Med. 2022 Jul 27;11(15):4362. doi: 10.3390/jcm11154362.
Right ventricular () dysfunction is associated with pulmonary vasoconstriction in mechanically ventilated patients. Enhancing the activity of angiotensin-converting enzyme 2 (2), a key enzyme of the renin-angiotensin system (), using recombinant human 2 (2) could alleviate -mediated vasoconstriction and vascular remodeling.
This prospective observational study investigated the association between concentrations of peptides (Ang II or Ang(1-7)) and markers of function, as assessed by echocardiography (ratio of to left ventricular end-diastolic area, interventricular septal motion, and pulmonary arterial systolic pressure ()).
Fifty-seven mechanically ventilated patients were enrolled. Incidence rates of acute cor pulmonale () and pulmonary circulatory dysfunction () were consistent with previous studies. In the 45 evaluable participants, no notable or consistent changes in peptides concentration were observed over the observation period, and there was no correlation between Ang II concentration and either or size. The model of the predicted posterior distributions for the pre- and post-dose values of Ang II demonstrated no change in the likelihood of after hypothetical dosing with 2, thus meeting the futility criteria. Similar results were observed with the other peptides evaluated.
Pre-defined success criteria for an association between and the plasma peptides were not met in the mechanically ventilated unselected patients.
在机械通气患者中，右心室（RV）功能障碍与肺血管收缩有关。使用重组人血管紧张素转换酶2（ACE2）增强肾素-血管紧张素系统（RAS）的关键酶血管紧张素转换酶2的活性，可减轻RAS介导的血管收缩和血管重塑。
这项前瞻性观察性研究调查了通过超声心动图评估的RV肽（血管紧张素II或血管紧张素1-7）浓度与RV功能标志物之间的关联（RV与左心室舒张末期面积之比、室间隔运动和肺动脉收缩压）。
纳入了57例机械通气患者。急性肺心病（AC）和肺循环功能障碍（PCD）的发生率与先前研究一致。在45例可评估的参与者中，在观察期内未观察到RV肽浓度有明显或一致的变化，并且血管紧张素II浓度与RV大小或PCD之间无相关性。血管紧张素II给药前和给药后预测后验分布的模型显示，在假设用ACE2给药后，RV的可能性没有变化，因此符合无效标准。对其他评估的RV肽也观察到了类似结果。
在未选择的机械通气患者中，未达到RV与血浆RV肽之间关联的预定义成功标准。
