重度继发性三尖瓣反流对左心室射血分数保留的心力衰竭患者静息和运动血流动力学的影响。
Impact of severe secondary tricuspid regurgitation on rest and exercise hemodynamics of patients with heart failure and a preserved left ventricular ejection fraction.
作者信息
Baratto Claudia, Caravita Sergio, Corbetta Giorgia, Soranna Davide, Zambon Antonella, Dewachter Céline, Gavazzoni Mara, Heilbron Francesca, Tomaselli Michele, Radu Noela, Perelli Francesco Paolo, Perego Giovanni Battista, Vachiéry Jean-Luc, Parati Gianfranco, Badano Luigi P, Muraru Denisa
机构信息
Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy.
出版信息
Front Cardiovasc Med. 2023 Mar 1;10:1061118. doi: 10.3389/fcvm.2023.1061118. eCollection 2023.
BACKGROUND
Both secondary tricuspid regurgitation (STR) and heart failure with preserved ejection fraction (HFpEF) are relevant public health problems in the elderly population, presenting with potential overlaps and sharing similar risk factors. However, the impact of severe STR on hemodynamics and cardiorespiratory adaptation to exercise in HFpEF remains to be clarified.
AIM
To explore the impact of STR on exercise hemodynamics and cardiorespiratory adaptation in HFpEF.
METHODS
We analyzed invasive hemodynamics and gas-exchange data obtained at rest and during exercise from HFpEF patients with severe STR (HFpEF-STR), compared with 1:1 age-, sex-, and body mass index (BMI)- matched HFpEF patients with mild or no STR (HFpEF-controls).
RESULTS
Twelve HFpEF with atrial-STR (mean age 72 years, 92% females, BMI 28 Kg/m) and 12 HFpEF-controls patients were analyzed. HFpEF-STR had higher ( < 0.01) right atrial pressure than HFpEF-controls both at rest (10 ± 1 vs. 5 ± 1 mmHg) and during exercise (23 ± 2 vs. 14 ± 2 mmHg). Despite higher pulmonary artery wedge pressure (PAWP) at rest in HFpEF-STR than in HFpEF-controls (17 ± 2 vs. 11 ± 2, = 0.04), PAWP at peak exercise was no more different (28 ± 2 vs. 29 ± 2). Left ventricular transmural pressure and cardiac output (CO) increased less in HFpEF-STR than in HFpEF-controls (interaction -value < 0.05). This latter was due to lower stroke volume (SV) values both at rest (48 ± 9 vs. 77 ± 9 mL, < 0.05) and at peak exercise (54 ± 10 vs. 93 ± 10 mL, < 0.05). Despite these differences, the two groups of patients laid on the same oxygen consumption isophlets because of the increased peripheral oxygen extraction in HFpEF-STR ( < 0.01). We found an inverse relationship between pulmonary vascular resistance and SV, both at rest and at peak exercise ( = 0.12 and 0.19, respectively).
CONCLUSIONS
Severe STR complicating HFpEF impairs SV and CO reserve, leading to pulmonary vascular de-recruitment and relative left heart underfilling, undermining the typical HFpEF pathophysiology.
背景
继发性三尖瓣反流（STR）和射血分数保留的心力衰竭（HFpEF）都是老年人群中重要的公共卫生问题，存在潜在重叠且具有相似的危险因素。然而，严重STR对HFpEF患者血流动力学及运动时心肺适应性的影响仍有待阐明。
目的
探讨STR对HFpEF患者运动血流动力学及心肺适应性的影响。
方法
我们分析了重度STR的HFpEF患者（HFpEF-STR）静息及运动时的有创血流动力学和气体交换数据，并与年龄、性别和体重指数（BMI）1:1匹配的轻度或无STR的HFpEF患者（HFpEF-对照）进行比较。
结果
分析了12例伴有心房STR的HFpEF患者（平均年龄72岁，92%为女性，BMI 28 Kg/m）和12例HFpEF-对照患者。HFpEF-STR在静息时（10±1 vs. 5±1 mmHg）和运动时（23±2 vs. 14±2 mmHg）的右心房压力均高于HFpEF-对照（P<0.01）。尽管HFpEF-STR静息时的肺动脉楔压（PAWP）高于HFpEF-对照（17±2 vs. 11±2，P = 0.04），但运动峰值时的PAWP并无差异（28±2 vs. 29±2）。HFpEF-STR患者左心室跨壁压和心输出量（CO）的增加幅度小于HFpEF-对照患者（交互作用P值<0.05）。这是由于静息时（48±9 vs. 77±9 mL，P<0.05）和运动峰值时（54±10 vs. 93±10 mL，P<0.05）的每搏输出量（SV）值较低。尽管存在这些差异，但由于HFpEF-STR患者外周氧摄取增加（P<0.01），两组患者处于相同的氧耗等量线上。我们发现静息和运动峰值时肺血管阻力与SV之间呈负相关（分别为P = 0.12和0.19）。
结论
并发于HFpEF的严重STR损害了SV和CO储备，导致肺血管失充盈和相对左心充盈不足，破坏了典型的HFpEF病理生理学。
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