Vizza C D, Lynch J P, Ochoa L L, Richardson G, Trulock E P
Department of Cardiology, La Sapienza University School of Medicine, Rome, Italy.
Chest. 1998 Mar;113(3):576-83. doi: 10.1378/chest.113.3.576.
To determine the prevalence of right and left ventricular dysfunction in a prescreened population of patients with severe pulmonary disease, and to analyze the relationship between right and left ventricular function.
Retrospective record review of 434 patients with severe pulmonary disease.
Patients with end-stage pulmonary disease, including alpha1-antitrypsin deficiency emphysema, COPD, cystic fibrosis (CF), idiopathic pulmonary fibrosis, and pulmonary hypertension (primary and Eisenmenger's syndrome), who were evaluated for lung transplantation between January 1993 and December 1995.
Pulmonary function tests, arterial blood gases, radionuclide ventriculography, two-dimensional transthoracic echocardiography, pulmonary hemodynamics, coronary angiography.
Right ventricular dysfunction (right ventricular ejection fraction [RVEF] <45%) was present in 267 patients (66%), but the prevalence was highest (94%) in patients with pulmonary vascular disease. Among the patients with airway or parenchymal lung disease, the prevalence ranged from 59% in COPD to 66% in CF. In contrast, left ventricular dysfunction (left ventricular ejection fraction [LVEF] <45%) was present in only 6.4%, but it, too, was most common in the group with pulmonary hypertension (19.6%). In the groups with parenchymal or airway disease, the prevalence was 3.6%, and there was no statistical difference among the four diagnoses (alpha1-antitrypsin deficiency emphysema; COPD; CF; idiopathic pulmonary fibrosis). LVEF showed a significant correlation with RVEF (r=0.44; p<0.05), and left ventricular dysfunction was associated with the presence of moderate-to-severe tricuspid regurgitation but not with coronary artery disease. In a subset of patients with both right and left ventricular dysfunction who subsequently underwent lung transplantation, RVEF and LVEF increased pari passu after transplantation.
The prevalence of right ventricular dysfunction is high in patients with end-stage pulmonary disease, but the prevalence of left ventricular dysfunction is relatively low. Left ventricular dysfunction appears to be related to right ventricular dysfunction, perhaps through ventricular interdependence.
确定在经过预筛选的重症肺部疾病患者人群中右心室和左心室功能障碍的患病率，并分析右心室和左心室功能之间的关系。
对434例重症肺部疾病患者进行回顾性记录审查。
1993年1月至1995年12月期间接受肺移植评估的终末期肺部疾病患者，包括α1抗胰蛋白酶缺乏性肺气肿、慢性阻塞性肺疾病（COPD）、囊性纤维化（CF）、特发性肺纤维化以及肺动脉高压（原发性和艾森曼格综合征）患者。
肺功能测试、动脉血气分析、放射性核素心室造影、二维经胸超声心动图、肺血流动力学、冠状动脉造影。
267例患者（66%）存在右心室功能障碍（右心室射血分数[RVEF]<45%），但在肺血管疾病患者中患病率最高（94%）。在气道或实质性肺部疾病患者中，患病率从COPD患者的59%到CF患者的66%不等。相比之下，仅6.4%的患者存在左心室功能障碍（左心室射血分数[LVEF]<45%），但在肺动脉高压组中也最为常见（19.6%）。在实质性或气道疾病组中，患病率为3.6%，四种诊断（α1抗胰蛋白酶缺乏性肺气肿；COPD；CF；特发性肺纤维化）之间无统计学差异。LVEF与RVEF呈显著相关性（r=0.44；p<0.05），左心室功能障碍与中重度三尖瓣反流的存在相关，但与冠状动脉疾病无关。在随后接受肺移植的同时存在右心室和左心室功能障碍的患者亚组中，移植后RVEF和LVEF同步增加。
终末期肺部疾病患者中右心室功能障碍的患病率较高，但左心室功能障碍的患病率相对较低。左心室功能障碍似乎与右心室功能障碍有关，可能是通过心室相互依存关系。
