Chuang P P, Wilson R F, Homans D C, Stone K, Bergman T, Bennett T D, Kubo S H
Cardiovascular Division, University of Minnesota, Minneapolis 55455, USA.
J Card Fail. 1996 Mar;2(1):41-6. doi: 10.1016/s1071-9164(96)80008-x.
Recent studies have demonstrated that pulmonary artery diastolic (PAD) pressure can be measured from a transducer positioned in the right ventricle (RV) based on the finding that PAD and RV pressures are equal at the time of pulmonary valve opening, which is associated with the time of maximum positive rate of pressure development (dP/dtmax) in the ventricle. The objective of this study was to assess the correlation between estimated PAD (ePAD) pressure, obtained through a RV transducer, and actual PAD (aPAD) pressure in patients with heart failure who have abnormal hemodynamics, reduced systolic function, and variable degrees of mitral regurgitation (MR) and tricuspid regurgitation (TR). Simultaneous measurements of pulmonary artery and RV pressures were obtained with a high-fidelity Millar catheter (Millar Instruments, Houston, TX) in 10 patients with New York Heart Association class III-IV heart failure who were being evaluated for cardiac transplantation. The overall correlation between ePAD and aPAD pressures was .92 (R2 = .878). This was not significantly different during the Valsalva maneuver (r = .96, R2 = .943), submaximal bicycle exercise (r = .87, R2 = .756), or infusions of dobutamine and nitroglycerin (r = .82, R2 = .730). The overall average difference between the average ePAD (24.6 +/- 7.0 mmHg) and aPAD (23.6 +/- 7.0 mmHg) pressures was 1.0 +/- 3.4 mmHg. The average difference between the two pressures in patients with mild to severe MR or TR was not different compared to those patients with no or trace MR or TR. The estimation of PAD pressure from an RV transducer is valid in patients with heart failure who have abnormal hemodynamics, reduced systolic function, and variable degrees of MR and TR. This correlation was observed at rest and during several provocative maneuvers. These data will be important for the development of a chronic, implantable hemodynamic monitor for patients with heart failure.
最近的研究表明，基于肺动脉舒张压（PAD）与右心室（RV）压力在肺动脉瓣开放时相等这一发现，可通过置于右心室内的传感器来测量PAD压力，而肺动脉瓣开放时间与心室压力上升最大正速率（dP/dtmax）的时间相关。本研究的目的是评估在血流动力学异常、收缩功能降低且存在不同程度二尖瓣反流（MR）和三尖瓣反流（TR）的心力衰竭患者中，通过右心室传感器获得的估计PAD（ePAD）压力与实际PAD（aPAD）压力之间的相关性。使用高保真米拉尔导管（米拉尔仪器公司，得克萨斯州休斯顿）对10例纽约心脏协会III - IV级心力衰竭且正在接受心脏移植评估的患者同时测量肺动脉和右心室压力。ePAD与aPAD压力之间的总体相关性为0.92（R² = 0.878）。在瓦尔萨尔瓦动作期间（r = 0.96，R² = 0.943）、次极量自行车运动期间（r = 0.87，R² = 0.756）或多巴酚丁胺和硝酸甘油输注期间（r = 0.82，R² = 0.730），这种相关性无显著差异。平均ePAD（24.6±7.0 mmHg）与aPAD（23.6±7.0 mmHg）压力之间的总体平均差异为1.0±3.4 mmHg。轻度至重度MR或TR患者的两种压力平均差异与无或微量MR或TR患者相比无差异。对于血流动力学异常、收缩功能降低且存在不同程度MR和TR的心力衰竭患者，通过右心室传感器估计PAD压力是有效的。在静息状态和几种激发动作期间均观察到这种相关性。这些数据对于开发用于心力衰竭患者的慢性可植入血流动力学监测器具有重要意义。
