Clinical Determinants and Prognostic Implications of Right Ventricular Dysfunction in Pulmonary Hypertension Caused by Chronic Lung Disease
Clinical Determinants and Prognostic Implications of Right Ventricular Dysfunction in Pulmonary Hypertension Caused by Chronic Lung Disease
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慢性肺病导致的肺动脉高压右心室功能障碍的临床决定因素和预后意义
DOI：
10.1161/jaha.118.011464
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发表时间：
2019-01-22
影响因子：
5.4
通讯作者：
Thenappan, Thenappan
中科院分区：
文献类型：
--
作者：
Prins, Kurt W.;Rose, Lauren;Thenappan, Thenappan
背景-由慢性肺病引起的肺动脉高压患者（第3组PH）有不成比例的右心室（RV）功能障碍，但第3组PH中RV功能障碍的相关性和临床意义尚不明确。方法和结果-我们对明尼苏达大学评估的147例第3组PH患者进行了队列研究。采用右心室面积变化分数（RVFAC）和（+）dP/dt（max）/瞬时压力定量右心室收缩功能。Tau和RV舒张刚度表征RV舒张功能。采用多元线性回归确定RVFAC的相关性。Kaplan-Meier和考克斯比例风险分析用于检查无心力衰竭住院和死亡。单因素分析显示RVFAC与肺动脉顺应性、心脏指数和左心室舒张期内径呈正相关。相反，男性、N末端脑钠肽前体、心率、右心房扩大、平均肺动脉压和肺血管阻力呈负相关。在调整肺血管阻力和肺动脉顺应性后，男性是RVFAC较低的最强预测因子。当比较性别时，无论是总体还是任何给定的平均肺动脉压和肺血管阻力值，男性的RVFAC均较低（26% vs 31%，P=0.03）。男性表现出减少（+）dP/dt（最大）/瞬时压力的肺血管阻力增加，而女性没有。RV舒张功能无性别差异。RV功能障碍（RVFAC
Background-Patients with pulmonary hypertension caused by chronic lung disease Group 3 PH) have disproportionate right ventricle (RV) dysfunction, but the correlates and clinical implications of RV dysfunction in Group 3 PH are not well defined.Methods and Results-We performed a cohort study of 147 Group 3 PH patients evaluated at the University of Minnesota. RV systolic function was quantified using right ventricular fractional area change (RVFAC) and (+)dP/dt(max)/instantaneous pressure. Tau and RV diastolic stiffness characterized RV diastolic function. Multivariate linear regression was used to define correlates of RVFAC. Kaplan-Meier and Cox proportional hazards analyses were used to examine freedom from heart failure hospitalization and death. Positive correlates of RVFAC on univariate analysis were pulmonary arterial compliance, cardiac index, and left ventricular diastolic dimension. Conversely, male sex, N-terminal pro-brain natriuretic peptide, heart rate, right atrial enlargement, mean pulmonary arterial pressure, and pulmonary vascular resistance were negative correlates. Male sex was the strongest predictor of lower RVFAC, after adjusting for pulmonary vascular resistance and pulmonary arterial compliance. When comparing sexes, males had lower RVFAC (26% versus 31%, P=0.03) both overall and for any given mean pulmonary arterial pressure and pulmonary vascular resistance value. Males exhibited a reduction in (+)dP/dt(max)/instantaneous pressure as pulmonary vascular resistance increased, whereas females did not. There were no sex differences in RV diastolic function. RV dysfunction (RVFAC