Pulmonary vascular resistance predicts early mortality in patients with diffuse fibrotic lung disease and suspected pulmonary hypertension
Pulmonary vascular resistance predicts early mortality in patients with diffuse fibrotic lung disease and suspected pulmonary hypertension
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DOI：
10.1136/thx.2008.112847
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发表时间：
2009-10-01
期刊：
影响因子：
10
通讯作者：
Wells, U.
中科院分区：
文献类型：
--
作者：
Corte, T. J.;Wort, S. J.;Wells, U.
背景：肺高压（PH）与弥漫性肺疾病（DLD）的不良预后相关。我们进行了一项研究，比较有创性和无创性参数在DLD和疑似ph患者中的预后意义。方法：回顾了连续行右心导管（RHC）的DLD患者的医院记录（n = 66）。平均肺动脉压（mPAP）、肺血管阻力（PVR）和非侵入性变量与早期（12个月内）和总死亡率进行比较。对早期死亡率进行了先验阈值检查。评估mPAP、PVR与无创标志物的关系。结果：50例RHC患者有PH(平均（SD） mPAP 33.5 (11.8) mm Hg, PVR 5.9 （4.3) Wood units (WU)）。PVR升高与早期死亡率密切相关(优势比（OR） 1.30；95%置信区间（CI） 1.11 ~ 1.52；p = 0.001)，调整年龄、性别、综合生理指标（CPI）和特发性肺纤维化诊断后，PVR >= 6.23 WU为最佳阈值（OR 11.09; 95% CI 2.54 ~ 48.36; p = 0.001）。早期死亡率与超声心动图显示的右心室扩张相关，但与其他非侵入性变量或mPAP无关。总体死亡率与CPI水平的上升密切相关。PVR与非侵入性变量的相关性为中等（R-2）
Background: Pulmonary hypertension (PH) is associated with a poor prognosis in diffuse lung disease (DLD). A study was undertaken to compare the prognostic significance of invasive and non-invasive parameters in patients with DLD and suspected PH.Methods: Hospital records of consecutive patients with DLD undergoing right heart catheterisation (RHC) were reviewed (n = 66). Mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and non-invasive variables were examined against early (within 12 months) and overall mortality. A priori thresholds were examined against early mortality. Relationships between mPAP, PVR and non-invasive markers were assessed.Results: Fifty patients had PH on RHC (mean (SD) mPAP 33.5 (11.8) mm Hg, PVR 5.9 (4.3) Wood units (WU)). Raised PVR was strongly associated with early mortality (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.11 to 1.52; p = 0.001), with PVR >= 6.23 WU being the optimal threshold after adjustment for age, gender, composite physiological index (CPI) and diagnosis of idiopathic pulmonary fibrosis (OR 11.09; 95% CI 2.54 to 48.36; p = 0.001). Early mortality was linked, albeit less strongly, to right ventricular dilation at echocardiography, but not to other non-invasive variables or mPAP. Overall mortality was most strongly associated with increasing CPI levels. Correlations between PVR and non-invasive variables were moderate (R-2