Ewert Ralf, Ittermann Till, Schmitt Delia, Pfeuffer-Jovic Elena, Stucke Johannes, Tausche Kristin, Halank Michael, Winkler Jörg, Hoheisel Andreas, Stubbe Beate, Heine Alexander, Seyfarth Hans-Jürgen, Opitz Christian, Habedank Dirk, Wensel Roland, Held Matthias
Internal Medicine B, Pneumology, University Hospital Greifswald, 17475 Greifswald, Germany.
Department of Community Medicine, University Hospital Greifswald, 17489 Greifswald, Germany.
J Cardiovasc Dev Dis. 2022 Oct 1;9(10):333. doi: 10.3390/jcdd9100333.
Background: Following acute pulmonary embolism (PE), a relevant number of patients experience decreased exercise capacity which can be associated with disturbed pulmonary perfusion. Cardiopulmonary exercise testing (CPET) shows several patterns typical for disturbed pulmonary perfusion. Research question: We aimed to examine whether CPET can also provide prognostic information in chronic thromboembolic pulmonary hypertension (CTEPH). Study Design and Methods: We performed a multicenter retrospective chart review in Germany between 2002 and 2020. Patients with CTEPH were included if they had ≥6 months of follow-up and complete CPET and hemodynamic data. Symptom-limited CPET was performed using a cycle ergometer (ramp or Jones protocol). The association of anthropometric data, comorbidities, symptoms, lung function, and echocardiographic, hemodynamic, and CPET parameters with survival was examined. Mortality prediction models were calculated by Cox regression with backward selection. Results: 345 patients (1532 person-years) were included; 138 underwent surgical treatment (pulmonary endarterectomy or balloon pulmonary angioplasty) and 207 received only non-surgical treatment. During follow-up (median 3.5 years), 78 patients died. The death rate per 1000 person-years was 24.9 and 74.2 in the surgical and non-surgical groups, respectively (p < 0.001). In age- and sex-adjusted Cox regression analyses, CPET parameters including peak oxygen uptake (VO2peak, reflecting cardiopulmonary exercise capacity) were prognostic in the non-surgical group but not in the surgical group. In mortality prediction models, age, sex, VO2peak (% predicted), and carbon monoxide transfer coefficient (% predicted) showed significant prognostic relevance in both the overall cohort and the non-surgical group. In the non-surgical group, Kaplan−Meier analysis showed that patients with VO2peak below 53.4% predicted (threshold identified by receiver operating characteristic analysis) had increased mortality (p = 0.007). Interpretation: The additional measurement of cardiopulmonary exercise capacity by CPET allows a more precise prognostic evaluation in patients with CTEPH. CPET might therefore be helpful for risk-adapted treatment of CTEPH.
急性肺栓塞（PE）后，相当一部分患者的运动能力下降，这可能与肺灌注紊乱有关。心肺运动试验（CPET）显示出几种典型的肺灌注紊乱模式。研究问题：我们旨在研究CPET是否也能为慢性血栓栓塞性肺动脉高压（CTEPH）提供预后信息。研究设计与方法：我们于2002年至2020年在德国进行了一项多中心回顾性病历审查。纳入了随访时间≥6个月且有完整CPET和血流动力学数据的CTEPH患者。使用功率自行车（斜坡或琼斯方案）进行症状限制性CPET。研究了人体测量数据、合并症、症状、肺功能以及超声心动图、血流动力学和CPET参数与生存率的关联。通过Cox回归和向后选择计算死亡率预测模型。结果：纳入345例患者（1532人年）；138例接受手术治疗（肺动脉内膜切除术或球囊肺动脉成形术），207例仅接受非手术治疗。在随访期间（中位时间3.5年），78例患者死亡。手术组和非手术组每1000人年的死亡率分别为24.9和74.2（p<0.001）。在年龄和性别调整的Cox回归分析中，CPET参数包括峰值摄氧量（VO2peak，反映心肺运动能力）在非手术组中具有预后意义，但在手术组中无此意义。在死亡率预测模型中，年龄、性别、VO2peak（预测值百分比）和一氧化碳转运系数（预测值百分比）在整个队列和非手术组中均显示出显著的预后相关性。在非手术组中，Kaplan-Meier分析显示，VO2peak低于预测值53.4%（通过受试者工作特征分析确定的阈值）的患者死亡率增加（p=0.007）。解读：通过CPET额外测量心肺运动能力可对CTEPH患者进行更精确的预后评估。因此，CPET可能有助于CTEPH的风险适应性治疗。
