左心室舒张功能障碍成人患者中肺动脉高压的患病率及预后意义

Prevalence and prognostic significance of pulmonary hypertension in adults with left ventricular diastolic dysfunction.

作者信息

Ratwatte Seshika, Playford David, Strange Geoff, Celermajer David S, Stewart Simon

机构信息

Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

出版信息

Open Heart. 2024 Dec 3;11(2):e003049. doi: 10.1136/openhrt-2024-003049.

DOI:10.1136/openhrt-2024-003049

PMID:39627022

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11624820/

Abstract

AIMS

Pulmonary hypertension (PHT) appears to be very common in heart failure with preserved ejection fraction but details on its prevalence, severity and prognostic implications have not been well defined. We, therefore, aimed to document PHT and its impact on mortality among adults with left ventricular (LV) diastolic dysfunction (LVDD).

METHODS

We analysed the profile and outcomes of 16 058 adults with LVDD (and with preserved LV ejection fraction, >50%) from the National Echocardiography Database of Australia. Subjects were classified according to their peak tricuspid regurgitation velocity (TRV), reflecting PHT risk, and we then evaluated the relationship between conventional thresholds of increasing risk of PHT and subsequent mortality, during median follow-up of 3.1 (IQR 1.6-5.2) years.

RESULTS

Mean age was 73±12 years and 9216 (57.4%) were female. Overall, 2611 (16.3%) had normal TRV levels (<2.5 m/s) indicative of no PHT, compared with 3471 (21.6%), 8450 (52.6%) and 1526 (9.5%) with TRV levels indicative of borderline (2.5-2.8 m/s), intermediate (2.9-3.4 m/s) and high-risk for PHT (>3.4 m/s). The 1-year and 5-year actuarial mortality (1701/1546 and 4232/8445 deaths, respectively) increased from 6.5% and 34.0% to 27.7% and 78.5%, respectively (p<0.0001), from normal to severely elevated TRV. Adjusted risk (HR) of mortality increased 1.28-fold (95% CI 1.15 to 1.41), 1.51-fold (95% CI 1.38 to 1.65) and 3.47-fold (95% CI 3.13 to 3.85) in those with borderline, intermediate and high risk of PHT versus normal TRV. This observation persisted when excluding atrial fibrillation cases, and when male and female cohorts were assessed separately. Mortality rates increased perceptibly at the second decile distribution of TRV (2.37-2.55 m/s) with a marked increase in mortality from the fifth decile (2.91-3.00 m/s) upwards.

CONCLUSION

We demonstrate the negative prognostic impact of elevated TRV levels in many adults with isolated LVDD. A threshold of increased mortality was observed at TRV levels equivalent to 'borderline risk' of PHT.

TRIAL REGISTRATION NUMBER

ACTRN12617001387314.

摘要

目的

肺动脉高压（PHT）在射血分数保留的心力衰竭患者中似乎非常常见，但其患病率、严重程度及对预后的影响等细节尚未明确界定。因此，我们旨在记录PHT及其对左心室（LV）舒张功能障碍（LVDD）成年患者死亡率的影响。

方法

我们分析了来自澳大利亚国家超声心动图数据库的16058例LVDD（且左心室射血分数保留，>50%）成年患者的资料和结局。根据反映PHT风险的三尖瓣反流峰值速度（TRV）对受试者进行分类，然后在3.1（四分位间距1.6 - 5.2）年的中位随访期内，评估PHT风险增加的传统阈值与随后死亡率之间的关系。

结果

平均年龄为73±12岁，9216例（57.4%）为女性。总体而言，2611例（16.3%）的TRV水平正常（<2.5 m/s），提示无PHT，相比之下，3471例（21.6%）、8450例（52.6%）和1526例（9.5%）的TRV水平分别提示临界（2.5 - 2.8 m/s）、中度（2.9 - 3.4 m/s）和PHT高风险（>3.4 m/s）。从正常TRV到严重升高的TRV，1年和5年精算死亡率（分别为1701/1546例和4232/8445例死亡）分别从6.5%和34.0%增至27.7%和78.5%（p<0.0001）。与正常TRV相比，PHT临界、中度和高风险患者的校正死亡风险（HR）分别增加1.28倍（95%CI 1.15至1.41）、1.51倍（95%CI 1.38至1.65）和3.47倍（95%CI 3.13至3.85）。排除心房颤动病例以及分别评估男性和女性队列时，这一观察结果依然存在。在TRV分布的第二个十分位数（2.37 - 2.55 m/s）时死亡率明显增加，从第五个十分位数（2.91 - 3.00 m/s）及以上死亡率显著上升。