在肺动脉高血压中右心室功能恢复的分类和预测因素
Franz P Rischard1, Roberto J Bernardo2, Rebecca R Vanderpool3
1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine (F.P.R., M.I.), University of Arizona, Tuscon.
Circulation. Heart failure
|September 4, 2023
概括
在肺动脉高血压患者中,右心室 (RV) 末端透析体积减少15毫升最能定义RV功能恢复 (RVFnRec). 这一指标预测了治疗后改善的运动能力和减少的临床恶化.
科学领域:
- 心脏病学 心脏病学
- 肺高血压研究 肺高血压研究
- 医学成像分析 医学成像分析
背景情况:
- 肺动脉高血压 (PAH) 治疗后右心室 (RV) 结构和功能的规范性变化尚未得到很好的定义.
- 该研究解决了与治疗相关的RV功能恢复 (RVFnRec) 的特征需要.
研究的目的:
- 评估在PAH患者中对RV功能恢复 (RVFnRec) 提出的定义的临床相关性.
- 确定特定的结构和功能参数,这些参数表明RV治疗后成功恢复.
主要方法:
- 评估了63名发生的PAH患者,在诊断和后期治疗时使用心脏磁共振成像和右心脏导管.
- 将PAH患者与62名健康对照人进行比较,使用侵入性和非侵入性心肺运动测试.
- 定义RVFnRec使用接收器运行曲线分析,基于RV终端-扩张体积相对于峰值氧气消耗 (VO2峰值) 的治疗变化.
主要成果:
- 在RV终端透缩体积下降15毫升是确定RVFnRec (AUC,0.87;P=0.0001) 的最佳切线,接近对照值.
- 35%的患者实现了RVFnRec,并且与显著更大的临床恶化无关 (P=0.006).
- 在0.8mL/mmHg的RV合规性增加最好预测RVFnRec (AUC,0.76;P=0.001),RVFnRec患者在运动期间显示中风体积和心脏输出量增加.
结论:
- RVFnRec,定义为RV终端透缩体积的-15毫升下降,预测运动能力,没有临床恶化,以及RV功能接近正常化.
- 与其他后负载措施相比,对VR遵守的治疗改善是RVFnRec的优越预测指标.
- 在运动期间,RVFnRec与增强的RV输出储备有关.
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