Usefulness of ventilatory gas analysis for the non-invasive evaluation of the severity of chronic thromboembolic pulmonary hypertension
Usefulness of ventilatory gas analysis for the non-invasive evaluation of the severity of chronic thromboembolic pulmonary hypertension
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通气气体分析在无创评估慢性血栓栓塞性肺动脉高压严重程度中的作用
DOI：
10.1016/j.ijcard.2019.07.018
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发表时间：
2019
影响因子：
3.5
通讯作者：
Kohzuki M.
中科院分区：
文献类型：
--
作者：
Akizuki M;Sugimura K;Aoki T;Kakihana T;Tatebe S;Yamamoto S;Sato H;Satoh K;Shimokawa H;Kohzuki M.
背景慢性血栓栓塞性肺动脉高压（CTEPH）的特点是肺动脉器质性血栓性阻塞，伴肺血管储备减少。本研究旨在探讨通气气体分析参数的姿势变化是否有助于评估 CTEPH 患者的肺血流动力学。方法共纳入 44 例初诊 CTEPH 患者（CTEPH 组）、33 例改善 CTEPH 患者（平均肺动脉压 [mPAP]<25mmHg）和 25 例对照者。 CTEPH 改善的患者是指之前被诊断为 CTEPH 且已接受最佳治疗的无残留 PH 的患者。在仰卧位和坐位下检查各种肺功能参数，并计算姿势变化（Δ[仰卧 - 坐位]）。我们对 32 例 CTEPH 患者在首次球囊肺动脉成形术（BPA）前和随访期间检查了血流动力学和通气气体分析参数。结果 CTEPH 患者仰卧位呼气末二氧化碳分压（PETCO2）和 ΔPETCO2 均显着低于对照组（均 P<0.001），且这些参数与 mPAP 显着相关（R2=0.507，P<0.0001， R2=0.470，P<0.001，分别）。 CTEPH 改善的患者仰卧位 PETCO2 和 ΔPETCO2 显着低于对照组（均 P<0.001）。两组的血流动力学和超声心动图参数相当。此外，mPAP 的变化与 BPA 引起的仰卧位 PETCO2 的变化之间存在显着相关性（R2=0.478，P<0.001）。结论这些结果表明，通气气体分析参数的姿势变化对于评估 mPAP 是有用且非侵入性的方法，mPAP 是 CTEPH 严重程度的血流动力学参数之一。
BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is characterized by organic thrombotic obstructions in the pulmonary arteries with reduced pulmonary vascular reserve. This study aimed to examine whether postural changes in ventilatory gas analysis parameters are useful for assessing pulmonary hemodynamics in patients with CTEPH.MethodsA total of 44 patients with newly diagnosed CTEPH (CTEPH group), 33 patients with improved CTEPH (mean pulmonary arterial pressure [mPAP] <25 mm Hg), and 25 controls were enrolled. Patients with improved CTEPH referred to patients without residual PH who were previously diagnosed with CTEPH and already received optimal therapies. Various pulmonary function parameters were examined in supine and sitting positions, and postural changes were calculated (Δ[supine − sitting]). In 32 patients with CTEPH, we examined hemodynamic and ventilatory gas analysis parameters before the first balloon pulmonary angioplasty (BPA) and during follow-up.ResultsPatients with CTEPH had significantly lower supine end-tidal carbon dioxide pressure (PETCO2) and ΔPETCO2than controls (bothP< 0.001), and these parameters were significantly correlated with mPAP (R2= 0.507,P< 0.0001 and R2= 0.470,P< 0.001, respectively). Supine PETCO2and ΔPETCO2were significantly lower in patients with improved CTEPH than in controls (bothP< 0.001). Hemodynamic and echocardiographic parameters were comparable in both groups. Furthermore, significant correlation between the change in mPAP and change in supine PETCO2by BPA was noted (R2= 0.478,P< 0.001).ConclusionThese results indicate that postural changes in ventilatory gas analysis parameters are useful and non-invasive method for the evaluation of mPAP, which is one of the hemodynamic parameters of CTEPH severity.