Sex differences in hemodynamic responses and long-term survival to optimal medical therapy in patients with pulmonary arterial hypertension.
Sex differences in hemodynamic responses and long-term survival to optimal medical therapy in patients with pulmonary arterial hypertension.
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DOI：
10.1007/s00380-018-1140-6
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发表时间：
2018-08
影响因子：
1.5
通讯作者：
Shimokawa H
中科院分区：
文献类型：
--
作者：
Kozu K;Sugimura K;Aoki T;Tatebe S;Yamamoto S;Yaoita N;Shimizu T;Nochioka K;Sato H;Konno R;Satoh K;Miyata S;Shimokawa H
众所周知，肺动脉高压（PAH）在女性中的发病率较高，而男性患者的预后较差。然而，现代PAH靶向治疗的血流动力学反应和长期预后的性别差异仍有待充分阐明。我们检查了1999年4月至2014年10月在我院诊断的129例连续PAH患者（34例男性和95例女性）的长期预后，并评估了PAH靶向治疗的血流动力学变化。与男性患者相比，女性患者的5年生存率更高（74.0 vs. 53.4%，P = 0.003）;然而，女性患者的年龄四分位数较高与不良结局相关。药物治疗后的随访检查显示，男性和女性的平均肺动脉压（mPAP）、肺血管阻力（PVR）和肺动脉容量（PAC）均显著降低（均P < 0.05），而只有女性的右心室舒张末期压（RVEDP），右心房压（RAP），心脏指数，混合静脉血氧饱和度（SvO 2）（均P < 0.05）。基线年龄仅在女性患者中与血流动力学变化显著相关，特别是RVEDP和RAP存在显著的性别交互作用（均P < 0.10）。多变量分析显示，男性患者基线时的SvO 2和随访时的mPAP和SvO 2是显著的预后因素，而女性患者mPAP、PVR和PAC的变化以及内皮素受体拮抗剂的使用是显著的预后因素。这些结果表明，女性PAH患者的长期预后优于男性，可能涉及右心室功能和血流动力学的更好改善。
It is widely known that the incidence of pulmonary arterial hypertension (PAH) is higher in female, whereas prognosis is poorer in male patients. However, sex differences in hemodynamic response to and long-term prognosis with PAH-targeted treatment in the modern era remain to be fully elucidated. We examined the long-term prognosis of 129 consecutive PAH patients (34 males and 95 females) diagnosed in our hospital from April 1999 to October 2014, and assessed hemodynamic changes in response to PAH-targeted therapy. Female patients had better 5-year survival compared with male patients (74.0 vs. 53.4%, P = 0.003); however, higher age quartiles in females were associated with poor outcome. Follow-up examination after medical treatment showed significant decreases in mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and pulmonary arterial capacitance (PAC) in both sexes (both P < 0.05), whereas only females had a significant improvement in right ventricular end-diastolic pressure (RVEDP), right atrial pressure (RAP), cardiac index, and mixed venous oxygen saturation (SvO2) (all P < 0.05). Baseline age significantly correlated with the hemodynamic changes only in female patients; particularly, there were significant sex interactions in RVEDP and RAP (both P < 0.10). The multivariable analysis showed that SvO2 at baseline and mPAP and SvO2 at follow-up were significant prognostic factors in males, whereas the changes in mPAP, PVR, and PAC and use of endothelin-receptor antagonist in females. These results indicate that female PAH patients have better long-term prognosis than males, for which better improvements of right ventricular functions and hemodynamics may be involved.
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影响因子：
7.5
作者：
McGoon, M. D.;Miller, D. P.
通讯作者：
Miller, D. P.
DOI：
10.1152/ajplung.00006.2015
发表时间：
2015-05-01
影响因子：
4.9
作者：
Frump, Andrea L.;Goss, Kara N.;Lahm, Tim
通讯作者：
Lahm, Tim
影响因子：
9.6
作者：
Kawut SM;Al-Naamani N;Agerstrand C;Berman Rosenzweig E;Rowan C;Barst RJ;Bergmann S;Horn EM
通讯作者：
Horn EM
DOI：
10.1183/09031936.00010409
发表时间：
2009-11
期刊：
The European respiratory journal
影响因子：
--
作者：
Austin ED;Cogan JD;West JD;Hedges LK;Hamid R;Dawson EP;Wheeler LA;Parl FF;Loyd JE;Phillips JA 3rd
通讯作者：
Phillips JA 3rd
影响因子：
37.8
作者：
Kawut SM;Lima JA;Barr RG;Chahal H;Jain A;Tandri H;Praestgaard A;Bagiella E;Kizer JR;Johnson WC;Kronmal RA;Bluemke DA
通讯作者：
Bluemke DA