Chau E M, Bailey K R, Mahoney D W, Frantz R P, McGregor C G, Daly R C, Edwards B S, Olson L J, Rodeheffer R J
Department of Biostatics, Mayo Clinic, Rochester, Minn 55905, USA.
Circulation. 1996 Nov 1;94(9 Suppl):II267-72.
Pulmonary hypertension remains a risk factor for early postoperative mortality in heart transplantation and may reduce the long-term benefits of the procedure. This study was undertaken to assess the value of baseline hemodynamic studies with nitroprusside used to predict the degree of postoperative reversibility of pulmonary hypertension in cardiac transplant recipients and to identify clinical risk factors for fixed pulmonary hypertension.
Hemodynamic data from 55 consecutive patients who underwent orthotopic cardiac transplantation from June 1988 through September 1993 were analyzed. The effects of nitroprusside and transplantation on pulmonary artery pressure, cardiac output, and pulmonary vascular resistance were compared. Multiple regression analysis was used to identify the predictors of reversibility of pulmonary hypertension. Nitroprusside reduced pulmonary vascular resistance by increasing cardiac output and, to a lesser extent, by reducing the transpulmonary gradient. Pulmonary hypertension was less reversible in patients with ischemic heart disease (versus dilated cardiomyopathy) and in former smokers (versus nonsmokers). Patients with nonischemic heart failure and no smoking history had significantly lower posttransplant pulmonary vascular resistance (1.24 +/- 0.45 Wood units) than ischemic patients (who were all former smokers; 2.20 +/- 1.01 wood units) or nonischemic former smokers (1.72 +/- 0.70 Wood units). The correlation of pulmonary vascular resistance during nitroprusside challenge with posttransplant pulmonary vascular resistance was better than that of baseline pulmonary vascular resistance with posttransplant pulmonary vascular resistance.
Nitroprusside testing improves the prediction of late posttransplant pulmonary vascular resistance; hence, it provides data that may be relevant to both early operative risk and later long-term effectiveness of cardiac transplantation. The finding of increased risk of fixed pulmonary hypertension associated with ischemic heart disease and smoking suggests that underlying atherosclerotic vascular disease may contribute to the irreversibility of pulmonary vascular resistance.
肺动脉高压仍然是心脏移植术后早期死亡的一个危险因素，并且可能降低该手术的长期益处。本研究旨在评估使用硝普钠进行基线血流动力学研究对预测心脏移植受者术后肺动脉高压可逆程度的价值，并确定固定性肺动脉高压的临床危险因素。
分析了1988年6月至1993年9月连续55例行原位心脏移植患者的血流动力学数据。比较了硝普钠和移植对肺动脉压、心输出量和肺血管阻力的影响。采用多元回归分析确定肺动脉高压可逆性的预测因素。硝普钠通过增加心输出量，在较小程度上通过降低跨肺压差来降低肺血管阻力。缺血性心脏病患者（与扩张型心肌病患者相比）和既往吸烟者（与非吸烟者相比）的肺动脉高压可逆性较差。非缺血性心力衰竭且无吸烟史的患者移植后肺血管阻力（1.24±0.45伍德单位）显著低于缺血性患者（均为既往吸烟者；2.20±1.01伍德单位）或非缺血性既往吸烟者（1.72±0.70伍德单位）。硝普钠激发试验期间的肺血管阻力与移植后肺血管阻力的相关性优于基线肺血管阻力与移植后肺血管阻力的相关性。
硝普钠试验改善了对移植后晚期肺血管阻力的预测；因此，它提供了可能与心脏移植早期手术风险和后期长期疗效相关的数据。与缺血性心脏病和吸烟相关的固定性肺动脉高压风险增加的发现表明，潜在的动脉粥样硬化性血管疾病可能导致肺血管阻力的不可逆性。
