Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension
Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension
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DOI：
10.1002/ejhf.192
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发表时间：
2015-01-01
影响因子：
18.2
通讯作者：
Aronson, Doron
中科院分区：
文献类型：
--
作者：
Dragu, Robert;Rispler, Shmuel;Aronson, Doron
反应性肺动脉高压（PH）是继发于左心衰（HF）的一种严重PH。鉴于肺血管结构和功能异常，发生在反应性PH，我们假设，肺动脉电容（PAC）可能会受到深刻的影响，与临床outcome.Methods和resultsWe研究了393 HF患者，其中124（32%）被归类为被动PH和140（36%）作为有反应性PH，肺动脉高压（PAH）91例。无PH患者的平均PAC最高（4.5 ± 2.1 mL/mmHg），其次是被动PH组（2.8 ± 1.4 mL/mmHg），反应性PH患者最低（1.8 ± 0.7 mL/mmHg）（P=0.0001）。PAC和肺血管阻力（PVR）符合双曲线反比关系（PAC=0.25/PVR，R-2=0.70），反应性PH患者几乎主要分布在曲线的平坦部分，PVR降低与PAC的小幅改善相关。PCWP升高与任何PVR的PAC显著降低相关（P=0.036）。在31个月的中位随访期间，反应性PH [风险比（HR）2.59，95%置信区间（CI）1.14-4.46，P=0.02]和PAC降低（每增加1 mL/mmHg，HR 0.72，95% CI 0.59-0.88，P=0.001）是独立的预测mortals.ConclusionsThe反应性PH的发展与PAC显着减少。PAC是HF死亡率的一个强有力的独立血液动力学标志物，可能导致与反应性PH相关的死亡率增加。
AimsReactive pulmonary hypertension (PH) is a severe form of PH secondary to left-sided heart failure (HF). Given the structural and functional abnormalities in the pulmonary vasculature that occur in reactive PH, we hypothesized that pulmonary artery capacitance (PAC) may be profoundly affected, with implications for clinical outcome.Methods and resultsWe studied 393 HF patients of whom 124 (32%) were classified as having passive PH and 140 (36%) as having reactive PH, and 91 patients with pulmonary arterial hypertension (PAH). Mean PAC was highest in patients without PH (4.52.1mL/mmHg), followed by the passive PH group (2.8 +/- 1.4mL/mmHg) and was lowest in those with reactive PH (1.8 +/- 0.7mL/mmHg) (P=0.0001). PAC and pulmonary vascular resistance (PVR) fitted well to a hyperbolic inverse relationship (PAC=0.25/PVR, R-2=0.70), with reactive PH patients dispersed almost predominantly on the flat part of the curve where a reduction in PVR is associated with a small improvement in PAC. Elevated PCWP was associated with a significant lowering of PAC for any PVR (P=0.036). During a median follow-up of 31 months, both reactive PH [hazard ratio (HR) 2.59, 95% confidence interval (CI) 1.14-4.46, P=0.02] and reduced PAC (HR 0.72 per 1mL/mmHg increase, 95% CI 0.59-0.88, P=0.001) were independent predictors of mortality.ConclusionsThe development of reactive PH is associated with a marked reduction in PAC. PAC is a strong independent haemodynamic marker of mortality in HF and may contribute to the increased mortality associated with reactive PH.