Progressive Dilatation of the Main Pulmonary Artery Is a Characteristic of Pulmonary Arterial Hypertension and Is Not Related to Changes in Pressure
Progressive Dilatation of the Main Pulmonary Artery Is a Characteristic of Pulmonary Arterial Hypertension and Is Not Related to Changes in Pressure
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DOI：
10.1378/chest.10-0363
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发表时间：
2010-12-01
期刊：
影响因子：
9.6
通讯作者：
Vonk-Noordegraaf, Anton
中科院分区：
文献类型：
--
作者：
Boerrigter, Bart;Mauritz, Gert-Jan;Vonk-Noordegraaf, Anton
背景肺动脉（PA）扩张是肺动脉高压（PAH）的后果之一，用于无创检测。目前尚不清楚PA的大小如何随时间变化以及是否与压力变化相关。本研究的目的是在随访期间评估PAH治疗患者的PA大小，以及其是否反映肺血管血流动力学。本研究纳入了1例接受了至少2次右侧心脏导管插入术（RHC）和心脏MRI（CMR）的PAH患者。另18例RHC时血压正常的患者纳入本研究进行基线比较。我们从CMR图像中得出PA压力和心输出量，我们得出PA直径（PAD）结果肺动脉高压组PAD明显大于非肺动脉高压组（P <0.01），PAD与升主动脉内径比值>平均随访时间为942天，在此期间有显著的扩张（P <0.01）。PAD的变化与压力和心输出量的变化无关，与随访时间中度相关。（r = 0.56，P <0.01）结论PA扩张有助于诊断PAM，但在随访过程中，PA的进行性扩张与PA压力和心输出量的变化无关，可能与血流动力学无关CHEST 2010，138（6）1395-1401
Background Pulmonary artery (PA) dilatation is one of the consequences of pulmonary arterial hypertension (PAH) and is used for noninvasive detection However, it is unclear how the size of the PA behaves over time and whether it is related to pressure changes The aim of this study was to evaluate PA size during follow-up in treated patients with PAH and whether it reflects pulmonary vascular hemodynamicsMethods Fifty-one patients with PAH who underwent at least two right-sided heart catheterizations (RHCs) together with cardiac MRI (CMR) were included in this study Another 18 patients who had normal pressure at RHC were included for comparison at baseline From RHC, we derived PA pressures and cardiac output From the CMR images we derived PA diameter (PAD) and the ratio of the PAD and ascending aorta diameterResults The PAD was significantly larger in patients with PAH than in patients without PAH (P < 001) A ratio of the PAD and ascending aorta diameter >1 had a positive predictive value of 92% for PAM Mean follow-up time was 942 days, and there was a significant dilatation during this period (P < 001) The change of the PAD did not correlate with the changes in pressure or cardiac output A moderate correlation with follow-up time was found (r =0 56, P < 001)Conclusions A dilatated PA is useful for identifying patients with PAM However, during patient follow-up, progressive dilatation of the PA is independent of the change m PA pressure and cardiac output and might become independent from hemodynamics CHEST 2010, 138(6) 1395-1401