Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study.
Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study.
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DOI：
10.1016/j.jacc.2008.11.051
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发表时间：
2009-03-31
影响因子：
24
通讯作者：
Redfield, Margaret M.
中科院分区：
文献类型：
--
作者：
Lam, Carolyn S. P.;Roger, Veronique L.;Rodeheffer, Richard J.;Borlaug, Barry A.;Enders, Felicity T.;Redfield, Margaret M.
明确射血分数正常心力衰竭（HFpEF）患者肺动脉高压（PH）的患病率、严重程度和意义。虽然已知HFpEF会引起PH，但其发展变化很大。缺乏基于人群的数据，肺静脉高压与肺动脉高压对HFpEF中PH的相对贡献尚不清楚。我们假设PH是症状性肺充血的标志物，将HFpEF与临床前高血压性心脏病（HTN）区分开来。对244例HFpEF患者（76± 13岁; 45%男性）进行了3年以上的多普勒超声心动图随访。对照组为719例无HF的HTN成人（66± 10岁; 44%为男性）。肺动脉收缩压（PASP）由三尖瓣返流速度推算，PH>35 mmHg定义为PASP。肺毛细血管楔压（PCWP）由E/e '估计。在HFpEF中，83%存在PH，中位（第25，第75百分位数）PASP为48（37，56）mmHg。PASP随PCWP增加而增加（r=0.21; p<0.007）。校正PCWP后，HFpEF的PASP高于HTN（p<0.001）。PASP可区分HFpEF和HTN，受试者工作曲线下面积为0.91（p<0.001），并可强烈预测HFpEF的死亡率（风险比=1.3/10 mmHg; p<0.001）。PH在HFpEF中非常普遍，并且通常是严重的。虽然肺静脉高压有助于PH，但它不能完全解释HFpEF中PH的严重程度，这表明肺动脉高压的一个组成部分也有贡献。PASP对死亡率的有效作用为针对HFpEF肺动脉高压的治疗提供了支持。
To define the prevalence, severity and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in the general community. While HFpEF is known to cause PH, its development is highly variable. Population-based data are lacking, and the relative contribution of pulmonary venous versus pulmonary arterial hypertension to PH in HFpEF is unknown. We hypothesized that PH would be a marker of symptomatic pulmonary congestion, distinguishing HFpEF from preclinical hypertensive heart disease (HTN). Population-based study of 244 HFpEF patients (76±13y; 45%male) followed from Doppler echocardiography over 3 years. Controls were 719 adults with HTN without HF (66±10y; 44%male). Pulmonary artery systolic pressure (PASP) was derived from the tricuspid regurgitation velocity and PH defined as PASP>35 mmHg. Pulmonary capillary wedge pressure (PCWP) was estimated from E/e’. In HFpEF, PH was present in 83% and median (25th, 75th percentile) PASP was 48 (37, 56) mmHg. PASP increased with PCWP (r=0.21; p<0.007). Adjusting for PCWP, PASP was higher in HFpEF than HTN (p<0.001). PASP distinguished HFpEF from HTN with an area under receiver-operating curve of 0.91 (p<0.001) and strongly predicted mortality in HFpEF (hazard ratio=1.3 per 10 mmHg; p<0.001). PH is highly prevalent and often severe in HFpEF. While pulmonary venous hypertension contributes to PH, it does not fully account for the severity of PH in HFpEF, suggesting that a component of pulmonary arterial hypertension also contributes. The potent effect of PASP on mortality lends support for therapies aimed at pulmonary arterial hypertension in HFpEF.
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