在患有异常性肺动脉高血压的患者中进行血管活性测试的流行率和特征
Goncharova Natalia1, Kirill Lapshin2, Aelita Berezina3
1Department of Noncoronary Disease, Almazov National Medical Research Center, Saint-Petersburg, Russia.
Annals of thoracic medicine
|February 10, 2025
概括
医生经常选择在异常性肺动脉高血压 (IPAH) 患者中不进行血管活性测试 (VRT). 阳性VRT患者的生存率明显高于阴性VRT患者或没有VRT患者.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 医学研究 医学研究
背景情况:
- 异常性肺动脉高血压 (IPAH) 的治疗策略取决于急性血管活性测试 (VRT) 的结果.
- 阳性VRT (VRT+) 表明适合通道阻断剂治疗,与优越的长期存活率相关.
- 了解VRT性能和患者特征对于优化IPAH管理至关重要.
研究的目的:
- 在IPAH患者中分析VRT的性能.
- 为了比较阳性VRT,阴性VRT和由于医生的决定而未接受VRT (ND VRT) 的患者之间的临床和血液动力学表现.
主要方法:
- 一项前性单中心研究包括166名成年IPAH患者 (2008-2023年).
- 吸入性伊洛普罗斯特用于VRT,通过Sitbon标准定义的积极结果.
- 标准评估包括心肺运动测试 (CPET) 和使用ESC/ERS风险尺度的风险评估.
主要成果:
- 51.2%的患者接受了VRT,其中15.6%的检测结果呈阳性.
- 与VRT+相比,负VRT与更差的血液动力学和运动耐受性有关.
- 由于医生的决定而导致的ND VRT是常见的,这些患者通常年龄较大,并表现出更高的风险标志物.
- 50%的VRT+患者在1.76年内发生了血管活性丧失.
- 五年生存率为VRT+的97%,VRT-的61%,ND VRT的53%.
结论:
- 医生的决定是不进行VRT的主要原因.
- 在基线中介至高风险标准预测了负VRT,ND VRT和血管活性损失.
- 建议在低风险或VRT+患者中更广泛地使用CPET,以早期检测PAH进展.
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