Circulation:肺动脉高压初始治疗后随访血流动力学变量的预后价值评估。

2017-11-26 fengxiangxin MedSci原创

诊断时的血流动力学变量(例如心脏指数和右心房压力(RAP))与肺动脉高压(PAH)患者的生存情况相关。最近的研究表明肺动脉顺应性(PCa)也可以预测PAH的预后。但是在开始治疗后其所能达到的预后重要程度尚不确定。

诊断时的血流动力学变量(例如心脏指数和右心房压力(RAP))与肺动脉高压(PAH)患者的生存情况相关。最近的研究表明肺动脉顺应性(PCa)也可以预测PAH的预后。但是在开始治疗后其所能达到的预后重要程度尚不确定。

研究者的目的是在PAH初始治疗后评估随访期间临床和血流动力学变量(包括PCa)对预后的重要性。在2006 - 2016年期间在法国肺动脉高压注册中心注册的患者中,研究者选择了有右心导管术(RHC)随访记录的特发性的、药物和毒素诱导的或可遗传的PAH患者作为研究对象。主要结果是死亡或肺移植。研究者使用了逐步Cox回归和受试者操作特征分析来评估在基线时和第一次RHC随访中获得的变量。

981例患者中,331例(33.7%)发生了主要终点事件,中位随访时间为2.8年(IQR25-75%,1.1-4.6)。在仅考虑基线变量的多变量模型中,没有血液动力学变量能够独立预测患者的预后。首次RHC随访的中位时间为4.6个月(3.7-7.8)(n = 763),研究者发现在对年龄、性别和PAH病因进行调整之后,纽约心脏协会(NYHA)功能分级、6分钟步行距离(6MWD)、每搏量指数(SVI)和右心房压力(RAP)与死亡或肺移植独立相关。 PCa不能独立预测基线或随访期间的结局。

SVI每下降10 mL / m2,调整后的风险比为1.28(95%CI 1.11-1.49,p <0.01);RAP每增加1mmHg,调整后的风险比为1.05(95%CI 1.02-1.09,p <0.01)。在随访的患者中中有2个(n = 355)或3个(n = 193)低风险预后因素特征的患者(保罗心脏指数≥2.5 L / min / m2,6MWD> 440 m以及NYHA分类为I或II或者低SVI)仍然与较高的死亡率或肺移植率有关(P <0.01)。

结论:初次PAH治疗后,首次RHC随访时,SVI和RAP是与死亡或肺移植独立相关的血液动力学变量。这些发现表明,对于PAH患者来说,SVI可能是比心脏指数更合适的治疗目标。

原始出处:

Weatherald J, Boucly A,et al.The Prognostic Value of Follow-up Hemodynamic Variables After Initial Management in Pulmonary Arterial Hypertension.Circulation. 2017 Oct 25. pii: CIRCULATIONAHA.117.029254. doi: 10.1161/CIRCULATIONAHA.117.029254.

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    2017-11-26 131****1460

    学习了受益匪浅

    0

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    2017-11-26 明心见性

    学习了.谢谢分享

    0

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    2017-11-26 小铭的皮普

    了解了

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