The Application of Intravascular Ultrasound to Evaluate Pulmonary Vascular Properties and Mortality in Patients with Pulmonary Arterial Hypertension
The Application of Intravascular Ultrasound to Evaluate Pulmonary Vascular Properties and Mortality in Patients with Pulmonary Arterial Hypertension
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DOI：
10.1016/j.echo.2015.08.018
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发表时间：
2016-02-01
影响因子：
6.5
通讯作者：
He, Ben
中科院分区：
文献类型：
--
作者：
Shen, Jie-yan;Cai, Zong-ye;He, Ben
背景资料：本研究旨在探讨血管内超声（IVUS）在评估肺动脉高压（PAH）患者肺血管特性和死亡率中的应用。所有患者均接受了右心导管插入术和IVUS，并被分为三组：与结缔组织疾病相关的PAH（组1，n = 25），其他原因所致的PAH（组2，n = 15）和无肺动脉高压的结缔组织疾病患者（组3，n = 11）。根据IVUS结果将PAH组（组1和组2）分为远端（n = 22）和近端（n = 18）重塑亚型。所有患者进行了随访（19 - 6 - 10个月），比较临床变量，肺血管特性，和生存率之间的差异。PAH组的平均壁厚大于第3组（P <0.01）。PAH组的肺血管机械性能，包括顺应性、扩张性、弹性模量和刚度指数β，均比第3组差（P <0.01），但第1组往往比第2组好。肺血管力学特性与血流动力学之间呈负指数关系，R2值在0.54 ~ 0.78之间（P <0.001）。肺动脉高压组中，第1组和第2组的死亡率相似（12% vs 13%，P > .05），而远端重构型的死亡率高于近端重构型（23% vs 0%，P < .05）。PAH近端和远端重构类型的分类可用于预测PAH患者的死亡率和评估预后。
Background: The aim of this study was to explore the application of intravascular ultrasound (IVUS) to evaluate pulmonary vascular properties and mortality in patients with pulmonary arterial hypertension (PAH).Methods: Patients (n = 51) with systolic pulmonary artery pressures >= 40 mm Hg on echocardiography were prospectively enrolled. All patients underwent right-heart catheterization and IVUS and were divided into three groups: PAH associated with connective tissue diseases (group 1, n = 25), PAH due to other causes (group 2, n = 15), and patients with connective tissue diseases without pulmonary hypertension (group 3, n = 11). PAH groups (groups 1 and 2) were divided into distal (n = 22) and proximal (n = 18) remodeling subtypes on the basis of IVUS results. All patients were followed (19 6 10 months) to compare the differences among clinical variables, pulmonary vascular properties, and survival rates.Results: A total of 408 segments of pulmonary arteries were studied. The PAH groups demonstrated a greater mean wall thickness than group 3 (P < .01 for all). Pulmonary vascular mechanical properties, including compliance, distensibility, elastic modulus, and stiffness index beta, were found to be worse in the PAH groups than in group 3 (P < .01 for all), but they tended to be better in group 1 than in group 2. An inverse exponential association was found between pulmonary vascular mechanical properties and hemodynamics, with R 2 values ranging from 0.54 to 0.78 (P < .001). In the PAH groups, the mortality in group 1 was similar to that in group 2 (12% vs 13%, P > .05), while the distal remodeling subtype had higher mortality than the proximal remodeling subtype (23% vs 0%, P < .05).Conclusions: IVUS is useful in PAH assessment by evaluating pulmonary vascular properties and predicting mortality. The classification of the proximal and distal remodeling type of PAH may be proposed to predict mortality and evaluate the prognosis of patients with PAH in clinical practice.