心力衰竭中的毛囊后肺高血压:PH-HF多中心研究中当前定义的影响
Charles Fauvel1,2,3, Thibaud Damy4, Emmanuelle Berthelot5,6
1Cardiology Department, Rouen University Hospital, F-76000 Rouen, France.
European heart journal
|July 26, 2024
概括
新的2022年欧洲指导方针对于心力衰竭 (HF) 中的毛囊后肺高血压 (pcPH) 增加了患病率,并将组合pcPH (CpcPH) 确定为更差的预后指标. 升高的肺动脉平均压力 (mPAP) 和肺血管阻力 (PVR) 预测了结果.
科学领域:
- 心脏病学 心脏病学
- 肺高血压是什么意思 肺高血压
- 心脏衰竭研究研究
背景情况:
- 2022年欧洲指南通过降低肺动脉平均压力 (mPAP) 和肺血管阻力 (PVR) 值,修订了心力衰竭 (HF) 中的毛囊后肺高血压 (pcPH) 定义.
- 这些修订的PCPH定义的临床影响和预后价值尚未被前性评估.
研究的目的:
- 为了前性地评估PCPH连续定义对PCPH患病率及其子组 (孤立与组合PCPH) 在稳定的左侧HF患者的影响.
- 通过多变量Cox回归分析,评估mPAP和PVR在所有死因或HF住院的预后价值.
主要方法:
- 一项多中心研究在2010年至2018年期间招募了662名稳定的左心肺炎患者,这些患者需要右心脏导管.
- 对患者进行了前性跟踪,以评估连续PCPH定义对流行率和子组分析的影响 (IpcPH与CpcPH).
- 用多变量考克斯回归来确定mPAP和PVR对主要结果 (全因死亡或HF住院) 的预后意义.
主要成果:
- 从25mmHg降低mPAP到20mmHg增加了PCPH发病率10%;从3WU降低PVR到2WU增加了PCPH (CpcPH) 综合发病率60%,显示出显著的净重新分类改善.
- 无论mPAP和PVR都是主要结果的显著预测因素 (mPAP的HR1.02,P=.01,PVR的HR1.07,P=.03).
- 预测主要结果的最佳PVR值约为2.2 WU. 使用2022年定义分类为PCPH的患者的生存率更差,CpcPH显示的结果明显比孤立PCPH (IpcPH) 更差.
结论:
- 这项研究首次强调了新PCPH定义对HF患者中CpcPH患病率的影响.
- 这些发现验证了mPAP> 20 mmHg和PVR> 2 WU的预后值,用于预测HF患者的不良结果.
- 修订后的定义和确定的值对于风险分层和肺高血压肺炎患者的管理至关重要.
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