在慢性阻塞性肺病中,左心室填充受损的特征和死亡风险
Mustafa Abdo1,2, Henrik Watz3,2, Peter Alter2,4
1LungenClinic Grosshansdorf and.
概括
在慢性阻塞性肺病 (COPD) 中,小左心室 (LV) 尺寸和心力衰竭与保留喷射分数 (HFpEF) 预测死亡率更高. 这些情况代表了COPD患者中LV填充功能受损的独特模式.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 慢性阻塞性肺病 (COPD) 的左心室 (LV) 填充受损可能源于心力衰竭与保存的喷射分数 (HFpEF) 或由于小的LV大小而减少的肺静脉回归.
- 区分这两种模式对于理解它们对死亡率的影响至关重要.
研究的目的:
- 调查小LV大小和HFpEF与COPD患者全因死亡率的相关性.
- 在这个人群中确定区分小LV和HFpEF的临床特征.
主要方法:
- 在COSYCONET队列中的1,752名稳定的COPD患者中,用于确定小LV (LV终端-透析直径低于正常) 和HFpEF特征的跨胸腔心声学 (TTE).
- 评估的关键参数包括E/A,E/e,N终端前脑性尿素,高灵敏性托罗邦素I,FEV1,残留体积和DlCO.
- 所有原因的死亡率被追踪了4.5年.
主要成果:
- 8%的患者有小LV,16%的患者有HFpEF特征,45%的患者有正常的TTE.
- 与正常TTE相比,小LV和HFpEF都与明显更高的全因死亡率相关 (HR分别为2.75和2.16).
- 小LV独立预测死亡率,其特点是LV填充量减少 (低E/A),但LV填充压力正常 (E/e) 和生物标志物水平较低.
结论:
- 小LV和HFpEF是COPD中受损的LV填充的独特回声心脏图案.
- 这两种模式独立地与COPD患者全因死亡率的增加有关.
- 临床特征和回声心脏学参数将小LV与HFpEF区分开来,有助于风险分层.
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