Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension
Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension
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DOI：
10.1016/s0735-1097(00)01212-2
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发表时间：
2001-03-15
影响因子：
24
通讯作者：
Chemla, D
中科院分区：
文献类型：
--
作者：
Castelain, V;Hervé, P;Chemla, D
本时域研究的目的是比较慢性肺血栓栓塞症（CPTE）和原发性肺动脉高压（PPH）患者的肺动脉（PA）脉压和波反射。背景肺动脉压力波形分析提供了一种简单而准确的时域右心室后负荷估计方法。慢性肺血栓栓塞和PPH都是导致严重肺动脉高压的原因。慢性肺血栓栓塞和PPH主要涉及近端和远端动脉，分别，并可能导致不同的PA压力waveform.METHODS高保真PA压力记录在14例患者（7男/7女，46 +/- 14岁）与CPTE（n = 7）和PPH（n = 7）。测量热稀释心输出量、平均肺动脉压（MPAP）、肺动脉脉压（PAPP =收缩-舒张期PAP）和标准化PAPP（nPAPP = PPAP/MPAP）。波反射通过测量Ti（即压力上升冲程和收缩期拐点（Pi）之间的时间）、Δ P（即收缩期PAP减去Pi的差）和增强指数来量化结果基线时CPTE和PPH的心指数相似（2.4 +/- 0.4 vs. 2.5 +/- 0.5 l/min/m（2）），平均PRP（59 +/- 9 vs. 59 +/- 10 mm Hg），PPAP（57 +/- 13 vs. 53 +/- 13 mm Hg）和nPPAP（0.97 +/- 0.16 vs. 0.89 +/- 0.13）。慢性肺血栓栓塞的Ti较短（90 +/- 17 vs. 126 +/- 16 ms，p < 0.01）和更高的P/PPAP（0.26 +/- 0.01 vs. 0.09 +/- 0.07，p < 0.01）.结论我们的研究表明：1）CPTE和PPH合并重度肺动脉高压时PA脉压相似，2）两组波反射均升高，且CPTE较PPH波反射增加且预期，从而表明右心室后负荷的脉动分量的差异。（美国科尔心脏病学杂志2001;37：1085-92）（C）2001年美国心脏病学会。
OBJECTIVES The purpose of this time-domain study was to compare pulmonary artery (PA) pulse pressure and wave reflection in chronic pulmonary thromboembolism (CPTE) and primary pulmonary hypertension (PPH).BACKGROUND Pulmonary artery pressure waveform analysis provides a simple and accurate estimation of right ventricular afterload in the time-domain. Chronic pulmonary thromboembolism and PPH are both responsible for severe pulmonary hypertension. Chronic pulmonary thromboembolism and PPH predominantly involve proximal and distal arteries, respectively, and may lead to differences in PA pressure waveform.METHODS High-fidelity PA pressure was recorded in 14 patients (7 men/7 women, 46 +/- 14 years) with CPTE (n = 7) and PPH (n = 7). We measured thermodilution cardiac output, mean PA pressure (MPAP), PA pulse pressure (PAPP = systolic - diastolic PAP) and normalized PAPP (nPAPP = PPAP/MPAP). Wave reflection was quantified by measuring Ti, that is, the time between pressure upstroke and the systolic inflection point (Pi), DeltaP, that is, the systolic PAP minus Pi difference, and the augmentation index (DeltaP/PPAP).RESULTS At baseline, CPTE and PPH had similar cardiac index (2.4 +/- 0.4 vs. 2.5 +/- 0.5 l/min/m(2)), mean PRP (59 +/- 9 vs. 59 +/- 10 mm Hg), PPAP (57 +/- 13 vs. 53 +/- 13 mm Hg) and nPPAP (0.97 +/- 0.16 vs. 0.89 +/- 0.13). Chronic pulmonary thromboembolism had shorter Ti (90 +/- 17 vs. 126 +/- 16 ms, p < 0.01) and higher P/PPAP (0.26 +/- 0.01 vs. 0.09 +/- 0.07, p < 0.01).CONCLUSIONS Our study indicated that: 1) CPTE and PPH with severe pulmonary hypertension had similar PA pulse pressure, and 2) wave reflection is elevated in both groups, and CPTE had increased and anticipated wave reflection as compared with PPH, thus suggesting differences in the pulsatile component of right ventricular afterload. (J Am Coll Cardiol 2001;37:1085-92) (C) 2001 by the American College of Cardiology.