Unmasking right ventricular-arterial uncoupling during fluid challenge in pulmonary hypertension
Unmasking right ventricular-arterial uncoupling during fluid challenge in pulmonary hypertension
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DOI：
10.1016/j.healun.2021.11.019
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发表时间：
2022-02-14
影响因子：
8.9
通讯作者：
Tello, Khodr
中科院分区：
文献类型：
--
作者：
Kremer, Nils;Rako, Zvonimir;Tello, Khodr
背景：肺动脉高压（PH）患者在静息时经常表现出保留的右心室（RV）功能。然而，容量挑战可能会发现悬而未决的右心室功能障碍。我们的目的是评估毛细血管前 PH 患者容量挑战期间 RV-肺动脉 (RV-PA) 解偶联的生理和预后影响。方法：我们使用有创压力容量 (PV) 导管插入术前瞻性评估 32 名 PH 患者（肺动脉高压，n = 27；无法手术的慢性血栓栓塞性疾病，n = 5）和 4 名对照患者。在预负荷减少（下腔静脉球囊闭塞；基线）和急性容量负荷（20 秒内 200 ml 盐水）期间记录 PV 环。在基线和最大容量负荷 (MVL) 时获得收缩力（多搏收缩末弹性 [Ees]）、动脉弹性 (Ea) 和 RV-PA 耦合 (Ees/Ea)。 结果：MVL 时间中位[四分位距]为 19 [18-22] s。 PH 患者的 Ees/Ea 从基线 (0.89 [0.69-1.23]) 显着下降至 MVL (0.16 [0.12-0.34]; p < 0.001)，但在对照组中保持稳定（基线：1.08 [0.94-1.80]；MVL：1.01 [0.80-2.49]；p = 0.715）。 Ees 也观察到相同的模式，而 Ea 保持不变。液体挑战期间 RV-PA 耦合 (DEes/Ea) 的下降百分比与肺静息血流动力学、RV 射血分数 (RVEF) 和 RV 舒张末期容积显着相关。 Kaplan-Meier 分析显示，DEes/Ea 较小的 PH 患者（
BACKGROUND: Patients with pulmonary hypertension (PH) frequently show preserved right ventricular (RV) function at rest. However, volume challenge may uncover pending RV dysfunction. We aimed to assess the physiological and prognostic impact of RV-pulmonary arterial (RV-PA) uncoupling during volume challenge in patients with precapillary PH.METHODS: We prospectively assessed 32 patients with PH (pulmonary arterial hypertension, n = 27; inoperable chronic thromboembolic disease, n = 5) and 4 controls using invasive pressure-volume (PV) catheterization. PV loops were recorded during preload reduction (balloon occlusion of inferior vena cava; baseline) and acute volume loading (200 ml saline in 20 s). Contractility (multi-beat end systolic elastance [Ees]), arterial elastance (Ea), and RV-PA coupling (Ees/Ea) were obtained at baseline and at maximum volume loading (MVL).RESULTS: Median [interquartile range] time to MVL was 19 [18-22] s. Ees/Ea significantly declined from baseline (0.89 [0.69-1.23]) to MVL (0.16 [0.12-0.34]; p < 0.001) in patients with PH but remained stable in controls (baseline: 1.08 [0.94-1.80]; MVL: 1.01 [0.80-2.49]; p = 0.715). The same pattern was observed for Ees, while Ea remained unchanged. The percent decline of RV-PA coupling (DEes/Ea) during fluid challenge was significantly associated with pulmonary resting hemodynamics, RV ejection fraction (RVEF), and RV end-diastolic volume. Kaplan-Meier analysis revealed that patients with PH who had a smaller DEes/Ea (