Dynamic Nature of Pulmonary Artery Systolic Pressure in Decompensated Heart Failure With Preserved Ejection Fraction: Role of Functional Mitral Regurgitation
Dynamic Nature of Pulmonary Artery Systolic Pressure in Decompensated Heart Failure With Preserved Ejection Fraction: Role of Functional Mitral Regurgitation
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DOI：
10.1016/j.cardfail.2013.09.006
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发表时间：
2013-11-01
影响因子：
6
通讯作者：
Le Jemtel, Thierry H.
中科院分区：
文献类型：
--
作者：
Ennezat, Pierre Vladimir;Marechaux, Sylvestre;Le Jemtel, Thierry H.
背景：肺动脉高压（PH）在射血分数保留的失代偿性心力衰竭（HFpEF）中很常见。我们研究了肺动脉收缩压（PASP）和功能性二尖瓣返流（FMR）的影响，一个补偿状态的回报：二维多普勒超声心动图进行前瞻性的标准治疗开始前和48小时后，在37例HFpEF相关的呼吸困难住院治疗，在26例非HFpEF相关的呼吸困难住院治疗。HFpEF患者的左房容积指数、E/e '比值和PASP显著大于非HFpEF患者，E波减速时间显著短于非HFpEF患者。37例HFpEF患者中有32例在入院时出现FMR，而非HFpEF患者均未出现FMR。治疗48小时后，26名HFpEF患者的PASP下降幅度明显大于11名HFpEF患者（分别为-24和-9 mm Hg; P <0.0001），而非HFpEF患者的PASP保持不变。在HFpEF患者中，PASP的降低与血压、心率、左心室舒张末期容积、下腔静脉直径、E/A比值、E/e '比值、二尖瓣有效返流口面积（EROA）和E波减速时间的降低相关。PASP和二尖瓣EROA之间的相关性是唯一一个仍然显着的多变量analysis.Conclusions：无创监测的PASP和FMR在HFpEF失代偿期的发作表明，返回到一个补偿状态是与PASP和FMR显着减少。
Background: Pulmonary hypertension (PH) is prevalent in decompensated heart failure with preserved ejection fraction (HFpEF). We investigated the effect of a return to a compensated state on pulmonary artery systolic pressure (PASP) and functional mitral regurgitation (FMR).Methods and Results: Two-dimensional Doppler echocardiography was prospectively performed before initiation of standard therapy and 48 hours later in 37 patients hospitalized for HFpEF-related dyspnea and in 26 patients hospitalized for non-HFpEF related dyspnea. Left atrial volume index, and E/e ' ratio, and PASP were significantly greater and E-wave deceleration time significantly shorter in HFpEF than in non-HFpEF patients. Thirty-two of the 37 HFpEF had FMR on admission whereas none of the non-HFpEF patients had FMR. After 48 hours of therapy, the reduction in PASP was significantly greater in the 26 HFpEF patients who improved than in the 11 HFpEF patients who did not (-24 vs -9 mm Hg, respectively; P < .0001), whereas PASP remained unchanged in non-HFpEF patients. The decrease in PASP correlated in HFpEF patients with reductions in blood pressure, heart rate, left ventricular end-diastolic volume, inferior vena cava diameter, E/A ratio, E/e ' ratio, mitral effective regurgitant orifice area (EROA), and E-wave deceleration time. The correlation between PASP and mitral EROA was the only one that remained significant by multivariate analysis.Conclusions: Noninvasive monitoring of PASP and FMR during an episode of HFpEF decompensation reveals that the return to a compensated state is associated with a significant reduction in PASP and FMR.