Clinical features do not identify risk of progression from isolated postcapillary pulmonary hypertension to combined pre- and postcapillary pulmonary hypertension.
Clinical features do not identify risk of progression from isolated postcapillary pulmonary hypertension to combined pre- and postcapillary pulmonary hypertension.
复制标题
DOI：
10.1002/pul2.12249
复制
发表时间：
2023-04
影响因子：
2.6
通讯作者：
Brittain, Evan L.
中科院分区：
文献类型：
--
作者：
Babu, Gautam;Annis, Jeffrey S.;Garry, Jonah D.;Freiberg, Matthew S.;Hemnes, Anna R.;Brittain, Evan L.
肺动脉高压是左心衰竭的常见后遗症，可表现为孤立性毛细血管后肺动脉高压（Ipc‐PH）或毛细血管前和毛细血管后肺动脉高压（Cpc‐PH）。尚未描述从Ipc‐PH进展为Cpc‐PH的相关临床特征。我们从两次接受右心导管插入术（RHC）的患者中提取临床数据。IPC‐PH定义为平均肺动脉压>20 mmHg，肺毛细血管楔压>15 mmHg，肺血管阻力（PVR）< 3 WU。进展至Cpc-PH需要PVR增加至≥3 WU。我们进行了一项回顾性队列研究，对进展为Cpc-PH的受试者与仍为Ipc-PH的受试者进行了重复评估。（IQR 0.2，2.1），33%（50/153）发生了Cpc-PH。在比较两组基线时的单变量分析中，体重指数（BMI）和右心房压较低，而在进展的患者中，中度或更严重的二尖瓣返流（MR）的患病率更高。在年龄和性别校正的多变量分析中，仅BMI（OR 0.94，95% CI 0.90-0.99，p = 0.017，C = 0.655）和中度或重度MR（OR 3.00，95% CI 1.37-6.60，p = 0.006，C = 0.654）预测进展，但区分能力较差。这项研究表明，仅凭临床特征无法区分有发生Cpc-PH风险的患者，并支持需要进行分子和遗传学研究以确定进展的生物标志物。
Pulmonary hypertension is a common sequelae of left heart failure and may present as isolated postcapillary pulmonary hypertension (Ipc‐PH) or combined pre‐ and postcapillary pulmonary hypertension (Cpc‐PH). Clinical features associated with progression from Ipc‐PH to Cpc‐PH have not yet been described. We extracted clinical data from patients who underwent right heart catheterizations (RHC) on two separate occasions. Ipc‐PH was defined as mean pulmonary pressure >20 mmHg, pulmonary capillary wedge pressure >15 mmHg, and pulmonary vascular resistance (PVR) < 3 WU. Progression to Cpc‐PH required an increase in PVR to ≥3 WU. We performed a retrospective cohort study with repeated assessments comparing subjects that progressed to Cpc‐PH to subjects that remained with Ipc‐PH. Of 153 patients with Ipc‐PH at baseline who underwent a repeat RHC after a median of 0.7 years (IQR 0.2, 2.1), 33% (50/153) had developed Cpc‐PH. In univariate analysis comparing the two groups at baseline, body mass index (BMI) and right atrial pressure were lower, while the prevalence of moderate or worse mitral regurgitation (MR) was higher among those who progressed. In age‐ and sex‐adjusted multivariable analysis, only BMI (OR 0.94, 95% CI 0.90–0.99, p = 0.017, C = 0.655) and moderate or worse MR (OR 3.00, 95% CI 1.37–6.60, p = 0.006, C = 0.654) predicted progression, but with poor discriminatory power. This study suggests that clinical features alone cannot distinguish patients at risk for development of Cpc‐PH and support the need for molecular and genetic studies to identify biomarkers of progression.
登录
查看更多内容
影响因子：
2.6
作者：
Meoli, David F.;Su, Yan Ru;Monahan, Ken
通讯作者：
Monahan, Ken
影响因子：
18.2
作者：
Dragu, Robert;Rispler, Shmuel;Aronson, Doron
通讯作者：
Aronson, Doron
影响因子：
4.3
作者：
Alfraidi H;Qanash S;Bshouty Z
通讯作者：
Bshouty Z
影响因子：
2.6
作者：
Bayram, Zubeyde;Dogan, Cem;Ozdemir, Nihal
通讯作者：
Ozdemir, Nihal
影响因子：
37.8
作者：
Maron BA;Hess E;Maddox TM;Opotowsky AR;Tedford RJ;Lahm T;Joynt KE;Kass DJ;Stephens T;Stanislawski MA;Swenson ER;Goldstein RH;Leopold JA;Zamanian RT;Elwing JM;Plomondon ME;Grunwald GK;Barón AE;Rumsfeld JS;Choudhary G
通讯作者：
Choudhary G