Diagnostic Performance of Pulmonary Capacitance at Rest and During Exercise in Idiopathic Pulmonary Arterial Hypertension
Diagnostic Performance of Pulmonary Capacitance at Rest and During Exercise in Idiopathic Pulmonary Arterial Hypertension
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DOI：
10.1016/j.hlc.2017.10.019
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发表时间：
2019-02-01
影响因子：
2.6
通讯作者：
Keogh, Anne
中科院分区：
文献类型：
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作者：
Jain, Pankaj;Rao, Sriram;Keogh, Anne
背景肺动脉高压（PAH）需要可靠的早期疾病标志物。作为措施的贡献异常血管顺应性的整体血管阻力，静息和运动肺容量的定义为每搏输出量除以肺动脉脉压的变化，可能是早期diseases.Methods的敏感标志物，我们检查了所有患者在我们的肺动脉高压数据库与特发性PAH，谁经历了休息和运动右心导管在一坐。获得标准的血液动力学测量结果，包括肺电容。这些结果进行了比较，年龄和性别匹配的正常controls.Results我们分析了27右心导管在特发性肺动脉高压患者和23在控制。平均肺动脉压（MPAP）、平均肺毛细血管楔压（mPCWP）、肺血管阻力（PVR）和右心室每搏作功指数（RVSWI）在基线时显著升高，而心脏指数（CI）和肺容量显著降低。两组运动后MPAP、mPCWP、心脏指数和RVSWI均显著升高。两组肺电容均显著降低。仅对照组的肺血管阻力随运动而降低。电容和PVR呈负相关，在休息（时间常数为0.79秒）和运动（时间常数为0.56秒）。作为诊断标志物的电容的受试者工作特征（ROC）曲线表明，在休息和0.95与exercise.Conclusions在特发性肺动脉高压（IPAH）的AUC为0.96，有一个减少在基线和左移的反向电容PVR的关系与运动的肺电容。静息和运动肺电容都有可能作为早期疾病的诊断标志物。
Background Reliable markers of early disease are needed in pulmonary arterial hypertension (PAH). As measures of the contribution of abnormal vascular compliance to overall vascular resistance, resting and exercise pulmonary capacitance-defined as the stroke volume divided by the change in pulmonary pulse pressure-may be sensitive markers of early disease.Methods We examined all patients in our pulmonary hypertension database with idiopathic PAH, who had undergone rest and exercise right heart catheterisation in one sitting. Standard haemodynamic measurements were obtained, including pulmonary capacitance. These results were compared to age- and sex-matched normal controls.Results We analysed 27 right heart catheterisations in idiopathic PAH patients and 23 in controls. Mean pulmonary artery pressure (MPAP), mean pulmonary capillary wedge pressure (mPCWP), pulmonary vascular resistance (PVR) and right ventricular stroke work index (RVSWI) were significantly higher at baseline in diseased patients, while Cardiac Index (CI) and pulmonary capacitance were significantly lower. MPAP, mPCWP, cardiac index and RVSWI increased significantly in both groups with exercise. Pulmonary capacitance decreased significantly in both groups. Pulmonary vascular resistance decreased with exercise in the control group only. Capacitance and PVR were inversely correlated at rest (time-constant of 0.79 s) and with exercise (time-constant of 0.56 s). The receiver operating characteristic (ROC) curve for capacitance as a diagnostic marker demonstrated an AUC of 0.96 at rest and 0.95 with exercise.Conclusions In idiopathic pulmonary arterial hypertension (IPAH) there is a reduction in pulmonary capacitance at baseline and left-shift of the inverse capacitance-PVR relationship with exercise. Both resting and exercise pulmonary capacitance have potential as diagnostic markers in early disease.