慢性血栓栓塞性肺动脉高压的左心室充盈压。
Left Ventricular Filling Pressure in Chronic Thromboembolic Pulmonary Hypertension.
机构信息
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Department of Cardiology, S. Elia Hospital, Caltanissetta, Italy.
出版信息
J Am Coll Cardiol. 2023 Feb 21;81(7):653-664. doi: 10.1016/j.jacc.2022.11.049.
BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by obstruction of major pulmonary arteries with organized thrombi. Clinical risk factors for pulmonary hypertension due to left heart disease including metabolic syndrome, left-sided valvular heart disease, and ischemic heart disease are common in CTEPH patients.
OBJECTIVES
The authors sought to investigate prevalence and prognostic implications of elevated left ventricular filling pressures (LVFP) in CTEPH.
METHODS
A total of 593 consecutive CTEPH patients undergoing a first diagnostic right and left heart catheterization were included in this study. Mean pulmonary arterial wedge pressure (mPAWP) and left ventricular end-diastolic pressure (LVEDP) were utilized for assessment of LVFP. Two cutoffs were applied to identify patients with elevated LVFP: 1) for the primary analysis mPAWP and/or LVEDP >15 mm Hg, as recommended by the current pulmonary hypertension guidelines; and 2) for the secondary analysis mPAWP and/or LVEDP >11 mm Hg, representing the upper limit of normal. Clinical and echocardiographic features, and long-term mortality were assessed.
RESULTS
LVFP was >15 mm Hg in 63 (10.6%) and >11 mm Hg in 222 patients (37.4%). Univariable logistic regression analysis identified age, systemic hypertension, diabetes, atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume as significant predictors of elevated LVFP. Atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume remained independent determinants of LVFP in adjusted analysis. At follow-up, higher LVFPs were measured in patients who had meanwhile undergone pulmonary endarterectomy (P = 0.002). LVFP >15 mm Hg (P = 0.021) and >11 mm Hg (P = 0.006) were both associated with worse long-term survival.
CONCLUSIONS
Elevated LVFP is common, appears to be due to comorbid left heart disease, and predicts prognosis in CTEPH.
背景
慢性血栓栓塞性肺动脉高压（CTEPH）的特征是大肺动脉被机化血栓阻塞。左心疾病导致肺动脉高压的临床危险因素，如代谢综合征、左侧瓣膜性心脏病和缺血性心脏病，在 CTEPH 患者中很常见。
目的
作者旨在研究 CTEPH 患者左心室充盈压（LVFP）升高的患病率和预后意义。
方法
本研究共纳入 593 例连续接受首次诊断性右心和左心导管检查的 CTEPH 患者。平均肺动脉楔压（mPAWP）和左心室舒张末期压（LVEDP）用于评估 LVFP。采用两种截断值来识别 LVFP 升高的患者：1）主要分析中 mPAWP 和/或 LVEDP>15mmHg，符合当前肺动脉高压指南推荐；2）次要分析中 mPAWP 和/或 LVEDP>11mmHg，代表正常上限。评估临床和超声心动图特征以及长期死亡率。
结果
63 例（10.6%）患者的 LVFP>15mmHg，222 例（37.4%）患者的 LVFP>11mmHg。单变量逻辑回归分析确定年龄、系统性高血压、糖尿病、心房颤动、主动脉瓣钙化狭窄、二尖瓣反流和左心房容积是 LVFP 升高的显著预测因素。在调整分析中，心房颤动、主动脉瓣钙化狭窄、二尖瓣反流和左心房容积仍然是 LVFP 的独立决定因素。在随访中，已行肺动脉内膜切除术的患者 LVFP 更高（P=0.002）。LVFP>15mmHg（P=0.021）和>11mmHg（P=0.006）均与长期预后较差相关。
结论
LVFP 升高较为常见，似乎是由合并的左心疾病引起的，并可预测 CTEPH 的预后。
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