Shima Hideki, Tsujino Ichizo, Nakaya Toshitaka, Nakamura Junichi, Igarashi-Sugimoto Ayako, Sato Takahiro, Watanabe Taku, Ohira Hiroshi, Hisada Ryo, Kato Masaru, Tsuneta Satonori, Yokota Isao, Konno Satoshi
Department of Respiratory Medicine, Faculty of Medicine Hokkaido University Sapporo Japan.
Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine Hokkaido University Sapporo Japan.
J Am Heart Assoc. 2025 Aug 19;14(16):e042186. doi: 10.1161/JAHA.125.042186. Epub 2025 Aug 12.
Limited data exist on right ventricular (RV) function in lung disease/hypoxia-associated pulmonary hypertension (PH). We aimed to clarify the presence, characteristics, and clinical significance of RV dysfunction in patients with lung disease/hypoxia-associated PH.
We analyzed data from 3 groups of patients: those with lung disease/hypoxia-associated PH, those without PH, and those with pulmonary arterial hypertension (PAH). RV volume was assessed using cardiac magnetic resonance imaging, and RV pressure data were obtained by right heart catheterization and analyzed using dedicated software and a single-beat method. We then evaluated RV contractility by end-systolic elastance (Ees), diastolic function by β and end-diastolic elastance, and RV-pulmonary artery coupling by Ees/arterial elastance.
We studied 68 patients with lung disease/hypoxia-associated PH, 40 without PH, and 93 with PAH. In the lung disease/hypoxia-associated PH group, Ees was sustained (0.46 [95% CI, 0.26-0.75] mm Hg/mL), whereas β (0.035 [95% CI, 0.022-0.049]) and end-diastolic elastance (0.19 [95% CI, 0.11-0.38] mm Hg/mL) were higher, and Ees/arterial elastance was lower (0.59 [95% CI, 0.27-0.79]) compared with the no-PH group. There were no differences in these values between the groups with lung disease/hypoxia-associated PH and PAH. Ees/arterial elastance was significantly correlated with the 6-minute walk distance and associated with mortality (hazard ratio, 0.18 [95% CI, 0.04-0.79]) in the group with PAH, but it was not in the group with lung disease/hypoxia-associated PH. Similarly, whereas the group with PAH showed improvement in β and Ees/arterial elastance with pulmonary vasodilator therapy, such improvement was not observed in the group with lung disease/hypoxia-associated PH.
In lung disease/hypoxia-associated PH, RV contractility is preserved, whereas diastolic function and RV-pulmonary artery coupling are impaired. Further investigation is needed to elucidate the distinct clinical relevance of RV dysfunction in lung disease/hypoxia-associated PH.
关于肺部疾病/低氧相关肺动脉高压（PH）患者右心室（RV）功能的数据有限。我们旨在阐明肺部疾病/低氧相关PH患者右心室功能障碍的存在情况、特征及临床意义。
我们分析了3组患者的数据：肺部疾病/低氧相关PH患者、无PH患者以及肺动脉高压（PAH）患者。使用心脏磁共振成像评估右心室容积，通过右心导管检查获取右心室压力数据，并使用专用软件和单搏法进行分析。然后，我们通过收缩末期弹性（Ees）评估右心室收缩力，通过β和舒张末期弹性评估舒张功能，通过Ees/动脉弹性评估右心室-肺动脉耦合。
我们研究了68例肺部疾病/低氧相关PH患者、40例无PH患者和93例PAH患者。在肺部疾病/低氧相关PH组中，Ees维持在一定水平（0.46[95%CI，0.26 - 0.75]mmHg/mL），而β（0.035[95%CI，0.022 - 0.049]）和舒张末期弹性（0.19[95%CI，0.11 - 0.38]mmHg/mL）较高，与无PH组相比，Ees/动脉弹性较低（0.59[95%CI，0.27 - 0.79]）。肺部疾病/低氧相关PH组和PAH组之间这些值没有差异。在PAH组中，Ees/动脉弹性与6分钟步行距离显著相关且与死亡率相关（风险比，0.18[95%CI，0.04 - 0.79]），但在肺部疾病/低氧相关PH组中并非如此。同样，虽然PAH组在接受肺血管扩张剂治疗后β和Ees/动脉弹性有所改善，但在肺部疾病/低氧相关PH组中未观察到这种改善。
在肺部疾病/低氧相关PH中，右心室收缩力得以保留，而舒张功能和右心室-肺动脉耦合受损。需要进一步研究以阐明肺部疾病/低氧相关PH中右心室功能障碍的独特临床相关性。
