Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension
Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension
复制标题
DOI：
10.1093/ehjci/jex133
复制
发表时间：
2018-04-01
影响因子：
6.2
通讯作者：
Hoendermis, Elke S.
中科院分区：
文献类型：
--
作者：
Gorter, Thomas M.;van Veldhuisen, Dirk J.;Hoendermis, Elke S.
目的：许多具有保留射血分数（HFpEF）的心力衰竭患者由于左侧充血压力增加而发展为毛细血管后肺动脉高压（PH）。然而，一小部分患者出现了合并的毛细血管前PH值。我们研究了超声心动图右侧特征在HFpEF中区分毛细血管前和后PH值的价值，以侵入性血流动力学为金标准。方法和结果对102例同时行右心导管和超声心动图检查的HFpEF患者进行分析。患者分为“无PH”、“分离的毛细血管后PH”和“毛细血管后和前PH”。评估收缩期肺动脉压（SPAP）、三尖瓣环平面收缩偏移（TAPSE）、右心室-血管耦合（TAPSE/SPAP）和VO2-max。主要终点为全因死亡率。共纳入97例患者：孤立post-capillary PH值没有PH值22%,47%,31%后,pre-capillary博士post和患者pre-capillary PH值经常有糖尿病(47比24%,P = 0.04),有更多的心力衰竭住院(57比26%,P = 0.007)和较低的氧气摄入量(10与13毫升/分钟/公斤,P = 0.008),相比之下,那些孤立post-capillary博士post和患者pre-capillary PH值也有更多的减少TAPSE(17和21毫米,P = 0.001)和TAPSE / SPAP (0.3 vs 0.5, P < 0.001)。TAPSE/SPAP比值< 0.36对鉴别额外毛细前PH患者具有良好的准确性（c统计量0.86，敏感性86%，特异性79%）。TAPSE/SPAP比值与死亡率增加相关（HR 2.51 [95% CI 1.25-5.01], P = 0.009）。结论右心室-血管耦合异常可识别HFpEF患者和额外的毛细血管前PH值，并预测HFpEF的不良预后。
Aims Many patients with heart failure with preserved ejection fraction (HFpEF) develop post-capillary pulmonary hypertension (PH) due to increased left-sided filling pressures. However, a subset of patients develops combined postand pre-capillary PH. We studied the value of echocardiographic right-sided characterization for the discrimination between pre- vs. post-capillary PH in HFpEF, using invasive haemodynamics as gold standard.Methods and results 102 consecutive HFpEF patients with simultaneous right heart catheterization and echocardiography were identified. Patients were divided into: 'no PH', 'isolated post-capillary PH', and 'post-and pre-capillary PH'. Systolic pulmonary arterial pressure (SPAP), tricuspid valve annular plane systolic excursion (TAPSE), right ventricular-vascular coupling (TAPSE/SPAP), and VO2-max were assessed. Primary endpoint was all-cause mortality. A total of 97 patients were included: 22% no PH, 47% isolated post-capillary PH, and 31% post- and pre-capillary PH. Patients with post-and pre-capillary PH had more often diabetes mellitus (47 vs. 24%, P = 0.04), had more heart failure hospitalizations (57 vs. 26%, P = 0.007) and lower VO2-max (10 vs. 13 mL/min/kg, P = 0.008), compared with those with isolated post-capillary PH. Patients with post-and pre-capillary PH also had more reduced TAPSE (17 vs. 21 mm, P = 0.001) and TAPSE/SPAP (0.3 vs. 0.5, P < 0.001). TAPSE/SPAP ratio < 0.36 had a good accuracy to identify patients with additional pre-capillary PH (C-statistic 0.86, sensitivity 86% and specificity 79%). TAPSE/SPAP ratio was associated with increased mortality (HR 2.51 [95% CI 1.25-5.01], P = 0.009).Conclusion Abnormal right ventricular-vascular coupling identifies patients with HFpEF and additional pre-capillary PH, and predicts poor outcome in HFpEF.