肺动脉高压患者右心大小与右心室输出储备能力的相关性研究。
Association between right heart size and right ventricular output reserve in patients with pulmonary arterial hypertension.
机构信息
Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg GmbH at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Germany.
Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg GmbH at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
出版信息
Int J Cardiol. 2024 Dec 1;416:132466. doi: 10.1016/j.ijcard.2024.132466. Epub 2024 Aug 17.
OBJECTIVES
Right ventricular (RV) output reserve, defined as increase of cardiac output during exercise, is reduced in patients with pulmonary arterial hypertension (PAH). Aim of this study was to evaluate the association of right heart size measured by echocardiography and invasively measured RV function at rest and during exercise in PAH patients.
METHODS
Adult PAH-patients who received routine haemodynamic assessment at rest and during exercise by right heart catheterisation and echocardiographic measurement of right heart size (right atrial (RA) and RV area) were included in this study. Clinical, echocardiographic, laboratory, exercise and invasive haemodynamic parameters were retrospectively analysed. The primary endpoint was to assess the association between right heart size and right ventricular function.
RESULTS
Data from 215 PAH patients (age 58.9 ± 15.9 years, 63.3% female, 62.2% double or triple combination treatment) were analysed in this cross-sectional study. Cardiac index was significantly lower for patients with enlarged RA-area > 18 cm at rest, and at 25 and 50 W (all p < 0.001) and for patients with enlarged RV area > 20 cm at rest, 25, 50 and 75 W (all p < 0.001). Furthermore, pulmonary vascular resistance and mPAP/CO slope (all p < 0.001) were significantly higher and pulmonary arterial compliance (all p < 0.05) was significantly lower in patients with enlarged RA or RV area. RA and RV area correlated with TAPSE/sPAP (both p < 0.001, R - 0.570 and - 0.530).
CONCLUSION
This study could underline that an enlargement of RA- and RV-area is associated with an impaired RV function at rest and during exercise in patients with PAH.
目的
右心室（RV）输出储备定义为运动时心输出量的增加，在肺动脉高压（PAH）患者中减少。本研究的目的是评估超声心动图测量的右心大小与 PAH 患者静息和运动时侵入性测量的 RV 功能之间的相关性。
方法
本研究纳入了接受右心导管插入术和超声心动图测量右心大小（右心房（RA）和 RV 面积）的常规静息和运动血流动力学评估的成年 PAH 患者。回顾性分析临床、超声心动图、实验室、运动和侵入性血流动力学参数。主要终点是评估右心大小与右心室功能之间的相关性。
结果
这项横断面研究分析了 215 名 PAH 患者的数据（年龄 58.9±15.9 岁，63.3%为女性，62.2%接受双重或三重联合治疗）。休息时 RA 面积>18cm 的患者的心脏指数明显较低，在 25 和 50W 时也是如此（均 p<0.001），休息时 RV 面积>20cm、25、50 和 75W 的患者也是如此（均 p<0.001）。此外，休息时、25、50 和 75W 时的肺血管阻力和 mPAP/CO 斜率（均 p<0.001）明显较高，而肺动脉顺应性（均 p<0.05）明显较低。RA 和 RV 面积与 TAPSE/sPAP 相关（均 p<0.001，R-0.570 和-0.530）。
结论
本研究表明，在 PAH 患者中，RA 和 RV 面积的增大与静息和运动时 RV 功能受损相关。
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