Feasibility of routine pulmonary arterial impedance measurements in pulmonary hypertension
Feasibility of routine pulmonary arterial impedance measurements in pulmonary hypertension
复制标题
DOI：
10.1378/chest.125.6.2121
复制
发表时间：
2004-06-01
期刊：
影响因子：
9.6
通讯作者：
Vachiéry, JL
中科院分区：
文献类型：
--
作者：
Huez, S;Brimioulle, S;Vachiéry, JL
目的：肺动脉阻抗（PVZ）谱是描述右心室（RV）后负荷的最佳方法，它整合了肺血管阻力（PVR）、弹性和波反射。我们评估了肺动脉高压（PAH）患者在常规右心导管和多普勒超声心动图中测定PVZ的可行性。设计：前瞻性研究。单位：学术医院。患者：22例PAH患者。干预措施：用充满液体的Swan-Ganz导管插入右心导管，多普勒超声心动图，并吸入一氧化氮（NO）[10至20 ppm]；静脉注射丙烯醇（平均8.5杯/kg/min， 5例）和静脉注射多巴酚丁胺（8杯/kg/min， 8例）的最大耐受剂量（17例）。测量和结果：PVZ由同步肺动脉压（Ppa）和血流波谱分析计算。平均（+/- SE） Ppa为63 +/- 3 mm Hg，平均PVR为16 +/- 2 Wood单位。PVZ谱明显向高于正常压力和频率的方向移动，平均0- hz阻抗（Z(0)）为1,506 +/- 138达因（.）s (.) cm(-5)，平均特征阻抗（Z(0)）为124 +/- 11达因（.）s (.) cm(-5)，与以往研究数据一致。吸入NO水平降低Ppa、PVR、Z(0)和Zc，心输出量无变化。给药不影响Ppa，增加心输出量，降低Z(0)和Zc。多巴酚丁胺增加心输出量和Ppa，降低PVR和Z(0)，但不改变Zc。结论：在常规右心导管和多普勒超声心动图中测定PVZ定量右心室后负荷是可行的。该测量对药物干预很敏感。
Objectives: Right ventricular (RV) afterload is best described by a pulmonary arterial impedance (PVZ) spectrum, which integrates pulmonary vascular resistance (PVR), elastance, and wave reflection. We evaluated the feasibility of PVZ determinations in patients with pulmonary arterial hypertension (PAH) during routine right heart catheterization and Doppler echocardiography.Design: Prospective study.Setting: Academic hospital.Patients: Twenty-two patients with PAH.Interventions: Right heart catheterization with a fluid-filled Swan-Ganz catheter, Doppler echocardiography, and administration of inhaled nitric oxide (NO) [10 to 20 ppm; 17 patients], maximum tolerated dose of IV epoprostenol (average, 8.5 mug/kg/min; 5 patients), and IV dobutamine (8 mug/kg/min; 8 patients).Measurements and results: PVZ was calculated from the spectral analysis of synchronized pulmonary artery pressure (Ppa) and flow waves. The mean (+/- SE) Ppa was 63 +/- 3 mm Hg, and the mean PVR was 16 +/- 2 Wood units. The PVZ spectrum was markedly shifted to higher than normal pressures and frequencies, with a mean 0-Hz impedance (Z(0)) of 1,506 +/- 138 dyne (.) s (.) cm(-5) and a mean characteristic impedance (Z(0)) of 124 +/- 11 dync (.) s (.) cm(-5), which are in keeping with data from previous studies. Inhaled NO levels decreased Ppa, PVR, Z(0), and Zc without a change in cardiac output. Epoprostenol administration did not affect Ppa, increased cardiac output, and decreased Z(0) and Zc. Dobutamine administration increased cardiac output and Ppa, and decreased PVR and Z(0), without changing Zc.Conclusions: The determination of PVZ to quantify RV afterload is feasible during routine right heart catheterization and Doppler echocardiography. The measurement is sensitive to pharmacologic interventions.