Hemodynamic trajectories and outcomes in patients with pulmonary arterial hypertension

被引：5

作者：

Amsallem, Myriam ^{[1
,2
]}

Bagherzadeh, Shadi P. ^{[1
]}

Boulate, David ^{[3
]}

Sweatt, Andrew J. ^{[4
,5
]}

Kudelko, Kristina T. ^{[4
,5
]}

Sung, Yon K. ^{[4
,5
]}

Feinstein, Jeffrey A. ^{[6
,7
]}

Fadel, Elie ^{[3
]}

Mercier, Olaf ^{[3
]}

Denault, Andre ^{[8
]}

Haddad, Francois ^{[1
,2
]}

Zamanian, Roham ^{[4
,5
]}

机构：

[1] Stanford Univ, Div Cardiovasc Med, Stanford, CA 94305 USA

[2] Stanford Univ, Stanford Cardiovasc Inst, Stanford, CA 94305 USA

[3] Hop Marie Lannelongue, INSERM UMR S 999, Le Plessis Robinson, France

[4] Stanford Univ, Div Pulm & Crit Care Med, Stanford, CA 94305 USA

[5] Vera Moulton Wall Ctr Pulm Vasc Dis Stanford, Stanford, CA USA

[6] Stanford Univ, Dept Pediat Cardiol, Stanford, CA 94305 USA

[7] Stanford Univ, Courtesy Bioengn, Stanford, CA 94305 USA

[8] Univ Montreal, Div Anesthesiol & Crit Care, Montreal, PQ, Canada

来源：

PULMONARY CIRCULATION | 2020年 / 10卷 / 04期

关键词：

outcomes; physiology; pulmonary circulation; pulmonary hypertension; right heart catheterization; PREDICTING SURVIVAL; MODEL; INSIGHTS; FAILURE;

D O I：

10.1177/2045894020941343

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The relative pulmonary to systemic pressure ratio (mean pulmonary arterial pressure/mean arterial pressure) has been proven to be valuable in cardiac surgery. Little is known on the prognostic value of baseline and trajectory of mean pulmonary arterial pressure/mean arterial pressure in pulmonary arterial hypertension. Patients with confirmed idiopathic, familial, drug and toxins, or connective tissue disease-related pulmonary arterial hypertension and at least one complete right heart catheterization were included and prospectively followed-up for 5.9 +/- 4.03 years. Correlates of the primary end point (i.e. death or lung transplant need) during follow-up were determined using Cox regression modeling. Results showed that among the 308 patients included, 187 had at least one follow-up catheterization (median time between catheterizations: 2.16 (1.16-3.19) years). In the total cohort (mean age 47.3 +/- 14.9 years, 82.8% of female and 58.1% in New York Heart Association class 3 or 4), mean pulmonary arterial pressure/mean arterial pressure (1.38 (1.07-1.77)) was associated with outcome (p = 0.01). Mean pulmonary arterial pressure/mean arterial pressure was incremental to a basic model (including right atrial pressure, systolic blood pressure, New York Heart Association class 3 or 4, and connective tissue disease) for outcome prediction, while mean pulmonary arterial pressure was not. In the 187 patients with a follow-up catheterization, both delta mean pulmonary arterial pressure and delta mean pulmonary arterial pressure/mean arterial pressure were associated with outcome (1.32 (1.11-1.58) and 1.31 (1.1-1.57) respectively, p < 0.01). Mean pulmonary arterial pressure and mean pulmonary arterial pressure/mean arterial pressure were both incremental to the basic model, while worsening in mean pulmonary arterial pressure or mean pulmonary arterial pressure/mean arterial pressure did not reach significance. In conclusion, mean pulmonary arterial pressure/mean arterial pressure at baseline prognosticates long-term outcome with a significant, albeit modest, incremental value to basic variables.

引用

页数：12

共 20 条

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