Hinderliter A L, Willis P W, Barst R J, Rich S, Rubin L J, Badesch D B, Groves B M, McGoon M D, Tapson V F, Bourge R C, Brundage B H, Koerner S K, Langleben D, Keller C A, Murali S, Uretsky B F, Koch G, Li S, Clayton L M, Jöbsis M M, Blackburn S D, Crow J W, Long W A
Department of Medicine, University of North Carolina, Chapel Hill 27599-7075, USA.
Circulation. 1997 Mar 18;95(6):1479-86. doi: 10.1161/01.cir.95.6.1479.
Right heart failure is an important cause of morbidity and mortality in primary pulmonary hypertension. In a recent prospective, randomized study of severely symptomatic patients, treatment with prostacyclin (epoprostenol) produced improvements in hemodynamics, quality of life, and survival. This article describes the echocardiographic characteristics of participants in this trial; the relationship of echocardiographic variables to hemodynamic parameters, exercise capacity, and quality of life; and the echocardiographic changes associated with prostacyclin therapy.
The 81 patients enrolled in this multicenter trial were randomized to treatment with a long-term infusion of prostacyclin in addition to conventional therapy (n = 41) or conventional therapy alone (n = 40) for 12 weeks. Echocardiograms and assessments of hemodynamics, exercise capacity, and quality of life were performed before and after the treatment phase. On baseline evaluation, patients had marked right ventricular dilatation and dysfunction, abnormal septal curvature, and significant tricuspid regurgitation with a high regurgitant velocity. Pericardial effusions were common. More pronounced abnormalities in right heart structure and function were associated with higher pulmonary arterial and mean right atrial pressures, lower cardiac index, and impaired exercise capacity but had no predictable relationship to quality-of-life indicators. The 12-week infusion of prostacyclin had beneficial effects on right ventricular size, curvature of the interventricular septum, and maximal tricuspid regurgitant jet velocity.
The echocardiographic manifestations of severe primary pulmonary hypertension reflect abnormalities in hemodynamics and exercise capacity. Prostacyclin has beneficial effects on right heart structure and function that may contribute to the clinical improvement and prolonged survival observed with this drug.
右心衰竭是原发性肺动脉高压发病和死亡的重要原因。在最近一项针对有严重症状患者的前瞻性随机研究中，前列环素（依前列醇）治疗改善了血流动力学、生活质量和生存率。本文描述了该试验参与者的超声心动图特征；超声心动图变量与血流动力学参数、运动能力和生活质量的关系；以及与前列环素治疗相关的超声心动图变化。
这项多中心试验纳入的81例患者被随机分为两组，一组除接受常规治疗外，还长期输注前列环素（n = 41），另一组仅接受常规治疗（n = 40），为期12周。在治疗阶段前后进行了超声心动图检查以及血流动力学、运动能力和生活质量评估。在基线评估时，患者存在明显的右心室扩张和功能障碍、室间隔曲率异常以及显著的三尖瓣反流且反流速度较高。心包积液很常见。右心结构和功能更明显的异常与较高的肺动脉压和平均右心房压、较低的心指数以及运动能力受损有关，但与生活质量指标没有可预测的关系。12周的前列环素输注对右心室大小、室间隔曲率和最大三尖瓣反流射流速度有有益影响。
严重原发性肺动脉高压的超声心动图表现反映了血流动力学和运动能力的异常。前列环素对右心结构和功能有有益影响，这可能有助于解释使用该药物观察到的临床改善和生存期延长。
