Pressure-Flow During Exercise Catheterization Predicts Survival in Pulmonary Hypertension
Pressure-Flow During Exercise Catheterization Predicts Survival in Pulmonary Hypertension
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DOI：
10.1016/j.chest.2016.02.634
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发表时间：
2016-07-01
期刊：
影响因子：
9.6
通讯作者：
Ulrich, Silvia
中科院分区：
文献类型：
--
作者：
Hasler, Elisabeth D.;Muller-Mottet, Severine;Ulrich, Silvia
背景：肺动脉高压表现为运动能力受损。我们的目的是探讨平均肺动脉压与心输出量的关系(mPAP/CO)是否可以预测肺动脉高压(PAH)和不能手术的慢性血栓栓塞性肺动脉高压(CTEPH)患者的无移植生存。方法：分析静息和仰卧位递增周期运动中PAH和CTEPH患者的右心导管血流动力学数据。结果：70例患者获得随访，平均年龄65[50；73]岁；平均动脉压34[29；44]mm Hg；心脏指数2.8[2.3；3.5][L/min]/m(2)。1年、3年、5年和7年的生存率分别为89%、81%、71%和59%。年龄、世界卫生组织功能分级、6分钟步行试验和混合静脉血氧饱和度(但不是静息血流动力学)可以预测无移植存活。最大负荷(危险比[HR]，0.94[95%CI，0.89-0.99]；P=.027)，峰值心脏指数(HR，0.51[95%CI，0.27-0.95]；P=.034)，心脏指数变化，0.25[95%CI，0.06-0.94]；P=.040)，mPAP/CO(HR，1.02[95%CI，1.01-1.03]；P=.003)。MPAP/CO的值预测3年无移植存活，曲线下面积为0.802(95%CI，0.66-0.95；P=0.004)。结论：在这组患有肺动脉高压或慢性高血压的患者中，运动时的压力-流量关系预测了无移植存活，并与疾病严重程度和预后的已建立的标志物相关。运动中的右心导管术可为肺动脉高压的治疗提供重要的辅助预后信息。
BACKGROUND: Pulmonary hypertension manifests with impaired exercise capacity. Our aim was to investigate whether the mean pulmonary arterial pressure to cardiac output relationship (mPAP/CO) predicts transplant-free survival in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).METHODS: Hemodynamic data according to right heart catheterization in patients with PAH and CTEPH at rest and during supine incremental cycle exercise were analyzed. Transplant-free survival and predictive value of hemodynamics were assessed by using Kaplan-Meier and Cox regression analyses.RESULTS: Seventy patients (43 female; 54 with PAH, 16 with CTEPH; median (quartiles) age, 65 [50; 73] years; mPAP, 34 [29; 44] mm Hg; cardiac index, 2.8 [2.3; 3.5] [L/min]/m(2)) were followed up for 610 (251; 1256) days. Survival at 1, 3, 5, and 7 years was 89%, 81%, 71%, and 59%. Age, World Health Organization-functional class, 6-min walk test, and mixed-venous oxygen saturation (but not resting hemodynamics) predicted transplant-free survival. Maximal workload (hazard ratio [HR], 0.94 [95% CI, 0.89-0.99]; P = .027), peak cardiac index (HR, 0.51 [95% CI, 0.27-0.95]; P = .034), change in cardiac index, 0.25 [95% CI, 0.06-0.94]; P = .040), and mPAP/CO (HR, 1.02 [ 95% CI, 1.01-1.03]; P = .003) during exercise predicted survival. Values for mPAP/CO predicted 3-year transplant-free survival with an area under the curve of 0.802 (95% CI, 0.66-0.95; P = .004).CONCLUSIONS: In this collective of patients with PAH or CTEPH, the pressure-flow relationship during exercise predicted transplant-free survival and correlated with established markers of disease severity and outcome. Right heart catheterization during exercise may provide important complementary prognostic information in the management of pulmonary hypertension.