Ventilatory efficiency slope correlates with functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension.
Ventilatory efficiency slope correlates with functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension.
复制标题
肺动脉高压的小儿患者的功能能力，结局和疾病严重程度相关。
DOI：
10.1016/j.ijcard.2013.10.012
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发表时间：
2013-11-30
影响因子：
3.5
通讯作者：
Ivy, D. Dunbar
中科院分区：
文献类型：
--
作者：
Rausch, Christopher M.;Taylor, Amy Lynne;Ross, Hayley;Sillau, Stefan;Ivy, D. Dunbar
关键词：
心脏运动试验广泛用于各种心血管疾病。通气效率斜率可以从次极量运动试验中得出。本研究旨在评估小儿肺动脉高压患者的呼吸效率斜率与功能能力、结局和疾病严重程度之间的关系。2001年至2011年，76名诊断为肺动脉高压（PH）的儿童和年轻人进行了258次心肺运动试验。每个单独的PH测试都与对照测试相匹配。将通气效率斜率与功能容量和疾病严重程度的传统测量进行比较，包括WHO功能分类、峰值耗氧量和肺动脉压和肺血管阻力的有创测量。肺动脉高压患者的通气效率斜率显著高于正常对照组（38.9 vs. 30.9，p <0.001），WHO分级每增加一级，通气效率斜率估计增加7.2（p <0.0001）。通气效率斜率与疾病严重程度的侵入性测量密切相关，包括肺血管阻力指数（r = 0.61）、肺动脉压（r = 0.58）、平均肺动脉压/平均主动脉压比（r = 0.52）和峰值VO2（r =-0.58）。12例预后不良患者（9例死亡，3例肺移植）的通气效率斜率与未发生预后不良的患者相比显著升高（51.1 vs. 37.9，p <0.001）。呼吸效率斜率与疾病严重程度的有创和无创标志物（包括峰值VO2、WHO功能分级和儿科PH患者的导管插入变量）相关性良好。呼吸效率斜率可能是疾病严重程度的有用无创标志物。
Cardiopulmonary exercise testing is widely used in a variety of cardiovascular conditions. Ventilatory efficiency slope can be derived from submaximal exercise testing. The present study sought to evaluate the relationship between ventilatory efficiency slope and functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension. Seventy six children and young adults with a diagnosis of pulmonary hypertension (PH) performed 258 cardiopulmonary exercise tests from 2001 to 2011. Each individual PH test was matched to a control test. Ventilatory efficiency slope was compared to traditional measures of functional capacity and disease severity including WHO functional classification, peak oxygen consumption, and invasive measures of pulmonary arterial pressures and pulmonary vascular resistance. Ventilatory efficiency slope was significantly higher in patients with pulmonary arterial hypertension, with an estimated increase of 7.2 for each increase in WHO class (p < 0.0001), compared with normal control subjects (38.9 vs. 30.9, p<0.001). Ventilatory efficiency slope correlated strongly with invasive measures of disease severity including pulmonary vascular resistance index (r =0.61), pulmonary artery pressure (r =0.58), mean pulmonary artery pressure/mean aortic pressure ratio (r =0.52), and peak VO2 (r=−0.58). Ventilatory efficiency slope in 12 patients with poor outcomes (9 death, 3 lung transplant), was significantly elevated compared to patients who did not (51.1 vs. 37.9, p<0.001). Ventilatory efficiency slope correlates well with invasive and noninvasive markers of disease severity including peak VO2, WHO functional class, and catheterization variables in pediatric patients with PH. Ventilatory efficiency slope may be a useful noninvasive marker for disease severity.
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