Loss of Vascular Distensibility During Exercise Is an Early Hemodynamic Marker of Pulmonary Vascular Disease
Loss of Vascular Distensibility During Exercise Is an Early Hemodynamic Marker of Pulmonary Vascular Disease
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DOI：
10.1378/chest.15-0125
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发表时间：
2016-02-01
期刊：
影响因子：
9.6
通讯作者：
Herve, Philippe
中科院分区：
文献类型：
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作者：
Lau, Edmund M. T.;Chemla, Denis;Herve, Philippe
背景：运动可以扩张正常顺应性的薄壁肺血管。扩张性丧失被认为是肺血管重塑的早期标志。我们假设，在轻度肺血管疾病 (PVD) 中，运动期间血管扩张性的降低发生在明显静息肺动脉高压 (PH) 的发展之前。 方法：使用肺循环模型和侵入性血流动力学数据对 90 名受试者进行了运动期间的扩张性 a（跨壁压每增加 mm Hg，血管直径的百分比变化）进行了估计。将无静息 PH 的轻度 PVD (PVD-noPH) (n = 33) 的可扩张特性与对照受试者 (n = 26) 和有明显静息 PH 的 PVD (PVD-PH) (n = 31) 进行比较。 结果：静息平均肺动脉压 (mPpa) 水平为 14 +/- 4、20 +/- 3 和 34 +/- 10 mm Hg，相应运动 mPpa-心脏对照组、PVD-noPH 组和 PVD-PH 组的输出斜率分别为 1.5 +/- 0.6、3.5 +/- 0.9 和 5.7 +/- 3.2 mm Hg/L/min。可扩展模型具有高精度和高精度，没有平均偏差，计算值和测量值 mPpa 之间的一致性限度为 -4.5 至 4.5 mm Hg，达到 95%。扩张性 α 在 PVD-PH 组中最低，在 PVD-noPH 组中中等，在对照组中最高（0.25 +/- 0.14%/mm Hg vs 0.45 +/- 0.24%/mm Hg vs 1.40 +/- 0.45%/ mm Hg，P
BACKGROUND: Exercise can distend the normally compliant, thin-walled pulmonary vessels. Loss of distensibility has been suggested as an early marker of pulmonary vascular remodeling. We hypothesized that in mild pulmonary vascular disease (PVD), a reduction in vascular distensibility during exercise occurs prior to the development of overt resting pulmonary hypertension (PH).METHODS: Distensibility a during exercise (percentage change in vessel diameter per mm Hg increase in transmural pressure) was estimated in 90 subjects using a model of the pulmonary circulation and invasive hemodynamic data. Distensible properties in mild PVD without resting PH (PVD-noPH) (n = 33) were compared with control subjects (n = 26) and PVD with overt resting PH (PVD-PH) (n = 31).RESULTS: Resting mean pulmonary artery pressure (mPpa) levels were 14 +/- 4, 20 +/- 3, and 34 +/- 10 mm Hg with corresponding exercise mPpa-cardiac output slopes of 1.5 +/- 0.6, 3.5 +/- 0.9, and 5.7 +/- 3.2 mm Hg/L/min for control subjects and the PVD-noPH and PVD-PH groups, respectively. The distensible model produced high accuracy and precision with no mean bias and 95% limits of agreement of -4.5 to 4.5 mm Hg between calculated and measured mPpa. Distensibility alpha was lowest in the PVD-PH group, intermediate in the PVD-noPH group, and highest in control subjects (0.25 +/- 0.14%/mm Hg vs 0.45 +/- 0.24%/mm Hg vs 1.40 +/- 0.45%/ mm Hg, P