ELEVATED PULMONARY-ARTERY PRESSURE - AN INDEPENDENT PREDICTOR OF MORTALITY
ELEVATED PULMONARY-ARTERY PRESSURE - AN INDEPENDENT PREDICTOR OF MORTALITY
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DOI：
10.1378/chest.99.1.112
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发表时间：
1991-01-01
期刊：
影响因子：
9.6
通讯作者：
CASTANER, A
中科院分区：
文献类型：
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作者：
COOPER, R;GHALI, J;CASTANER, A
这项研究的分析基于1371名以黑人为主的患者在右心和左心导管术期间获得的血流动力学和血管造影数据。对所有患者进行了平均117周的前瞻性随访，记录了103例死亡事件。在COX生存分析中，发现三个独立变量与生存相关：肺动脉平均压、狭窄血管数目和左心室射血分数(P<；0.01)；在多因素逐步分析中，PAMP以三个预后变量中最大的X~(-2)值最先进入模型(X~(-2)=33.4；P<；0.0001)。与存活者相比，死者的PAMP高出32%(25±11 mm Hgvs 19+8 mm Hg，p<；0.01[平均值，SD])，PAMP升高10 mm Hg与死亡相对风险增加4倍以上相关；这一发现与肺血管阻力无关，因此不能归因于原发性肺血管或实质性疾病。在1,118名左心室射血分数正常(50%)和253名射血分数降低(50%)的患者中，PAMP都是死亡率的独立预测因子(P<；0.0001和0.01)，因此是心脏收缩功能受损以外的心脏病的标志。在无阻塞性冠状动脉疾病的患者中，PAMP单独在多因素生存分析中提供了预后信息。
Analyses in this study were based on hemodynamic and angiographic data obtained in a cohort of 1,371 predominantly black patients during right and left heart catheterization. All patients were followed up prospectively for a mean of 117 weeks, and 103 fatal events were recorded. In Cox survival analysis, three variables were found to be independently related to survival: pulmonary artery mean pressure (PAMP), number of stenosed vessels, and left ventricular (LV) ejection fraction (p < 0.01); in multivariate stepwise analysis, PAMP entered the model first with the largest chi-2 value of the three prognostic variables (chi-2 = 33.4; p < 0.0001). The PAMP was 32 percent higher in decedents compared with survivors (25 + 11 mm Hg vs 19 + 8 mm Hg, p < 0.01 [mean, SD]) and a 10 mm Hg increase in PAMP was associated with a more than fourfold increase in the relative risk of dying; this finding was independent of pulmonary vascular resistance and therefore could not be attributed to primary pulmonary vascular or parenchymal disease. In both the subgroup of 1,118 patients with a normal LV ejection fraction (> 50 percent) and the 253 patients with a reduced ejection fraction (< 50 percent), PAMP emerged as an independent predictor of mortality (p < 0.0001 and 0.01, respectively), and is therefore a marker of cardiac disease beyond impairment of systolic contractile function. Among patients without obstructive coronary artery disease, PAMP alone provided prognostic information in the multivariate survival analysis.