The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension
The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension
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DOI：
10.1378/chest.13-1291
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发表时间：
2014-06-01
期刊：
影响因子：
9.6
通讯作者：
Noordegraaf, Anton Vonk
中科院分区：
文献类型：
--
作者：
Jacobs, Wouter;van de Veerdonk, Marielle C.;Noordegraaf, Anton Vonk
背景：男性是肺动脉高压（PAH）患者生存差的独立预测因子。这一发现可能与更严重的肺血管疾病、更差的右心室（RV）功能或对治疗的不同反应有关。本研究的目的是探讨多环芳烃治疗患者生存中性别差异的潜在原因。方法：对1999年2月至2011年1月在VU大学医学中心诊断的101例PAH患者（82例特发性，15例遗传性，4例厌食相关）进行回顾性队列研究，并行右侧心导管穿刺和心脏MRI评估右心室功能。肺血管阻力（PVR）的变化被用来衡量肺血管系统的治疗反应，而右心室射血分数（RVEF）的变化被用来评估右心室对治疗的反应。结果：男女基线时PVR和RVEF具有可比性；然而，与女性患者相比，男性患者的无移植生存期更差（P = 0.002）。尽管男性和女性患者在1年后的PVR下降相似，但女性患者的RVEF改善，而男性患者的RVEF恶化。在一项中介分析中，在校正混杂因素后，男性和女性无移植生存差异的39.0%是通过开始PAH药物治疗后RVEF的变化介导的。结论：本研究表明，特发性多环芳烃患者开始药物治疗时RVEF反应的差异解释了男性较差生存率的重要部分。
Background: Male sex is an independent predictor of worse survival in pulmonary arterial hypertension (PAH). This finding might be explained by more severe pulmonary vascular disease, worse right ventricular (RV) function, or different response to therapy. The aim of this study was to investigate the underlying cause of sex differences in survival in patients treated for PAH.Methods: This was a retrospective cohort study of 101 patients with PAH (82 idiopathic, 15 heritable, four anorexigen associated) who were diagnosed at VU University Medical Centre between February 1999 and January 2011 and underwent right-sided heart catheterization and cardiac MRI to assess RV function. Change in pulmonary vascular resistance (PVR) was taken as a measure of treatment response in the pulmonary vasculature, whereas change in RV ejection fraction (RVEF) was used to assess RV response to therapy.Results: PVR and RVEF were comparable between men and women at baseline; however, male patients had a worse transplant-free survival compared with female patients (P =.002). Although male and female patients showed a similar reduction in PVR after 1 year, RVEF improved in female patients, whereas it deteriorated in male patients. In a mediator analysis, after correcting for confounders, 39.0% of the difference in transplant- free survival between men and women was mediated through changes in RVEF after initiating PAH medical therapies.Conclusions: This study suggests that differences in RVEF response with initiation of medical therapy in idiopathic PAH explain a significant portion of the worse survival seen in men.