Effect of Acute Vasodilator Testing Using Oxygen in Pulmonary Hypertension Due to Left Heart Disease.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-03-01 Epub Date: 2024-01-10 DOI:10.1177/10892532241227082

Sundararaj Rajkumar, Ajay Kumar Jha, Satyen Parida, Chitra Rajeshwari Thangaswamy, Sakthirajan Panneerselvam, Sreevathsa K S Prasad

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引用次数: 0

Abstract

Background: Pulmonary vasodilators, including oxygen, have not shown consistent beneficial effects on pulmonary hypertension due to valvular heart disease (PH-VHD). Therefore, the study aimed to assess the effect of 100% fractional inspiration of oxygen (FiO₂) on pulmonary and systemic hemodynamics in patients with combined pre- and post-capillary pulmonary hypertension (CpcPH) and isolated post-capillary pulmonary hypertension (IpcPH) due to PH-VHD.

Methods: This prospective study was conducted among patients with PH-VHD undergoing mitral or aortic valve replacement or repair. The study was conducted after induction of anesthesia and pulmonary artery catheterization. Cardiac output was obtained using thermodilution and all direct, and derived hemodynamic variables were obtained at 30% and 100% FiO₂. The patients were stratified a priori into responders {(≥10 mmHg fall in mean pulmonary artery pressure (MPAP)} and non-responders.

Results: Fifty-seven patients completed the acute vasodilator test. The mean age and body mass index of the study population was 41.8 ± 14.1 years and 21.4 ± 4.6 kg/m², respectively. There was a significant decrease in MPAP (40.77 ± 12.07 mmHg vs 36.74 ± 13.3 mmHg; P < .001) and pulmonary vascular resistance (PVR) {(median; Interquartile range (IQR); 388; 371 vs 323; 362 dynes sec.cm^-5; P < .001) at 100% FiO₂. Transpulmonary gradient (TPG) and diastolic pulmonary gradient (DPG) also decreased significantly (P < .001 and P < .001). Cardiac output did not change significantly. The magnitude of decrease in MPAP, PVR, TPG, DPG, and pulmonary artery compliance (PAC) between CpcPH and IpcPH was comparable. Responders did not show a significantly greater fall in MPAP, PVR, TPG, DPG, and PAC after surgery.

Conclusion: Hyperoxia may lead to reduction in MPAP and PVR in both hemodynamic phenotypes of PH-VHD. A larger sample size is required to support or refute the findings of this study.

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使用氧气进行急性血管扩张剂测试对左心疾病所致肺动脉高压的影响

背景：包括氧气在内的肺血管扩张剂并未显示出对瓣膜性心脏病（PH-VHD）所致肺动脉高压的一致有益效果。因此，本研究旨在评估 100% 分数吸入氧（FiO2）对 PH-VHD 引起的合并毛细血管前后肺动脉高压（CpcPH）和孤立毛细血管后肺动脉高压（IpcPH）患者的肺和全身血流动力学的影响：这项前瞻性研究在接受二尖瓣或主动脉瓣置换或修补术的 PH-VHD 患者中进行。研究在麻醉诱导和肺动脉导管检查后进行。使用热稀释法获得心输出量，并在 30% 和 100% FiO2 条件下获得所有直接和衍生的血液动力学变量。事先将患者分为有反应者{（平均肺动脉压（MPAP）下降≥10 mmHg）}和无反应者：结果：57 名患者完成了急性血管扩张试验。研究人群的平均年龄和体重指数分别为 41.8 ± 14.1 岁和 21.4 ± 4.6 kg/m2。在 100% FiO2 条件下，MPAP（40.77 ± 12.07 mmHg vs 36.74 ± 13.3 mmHg；P < .001）和肺血管阻力（PVR）{（中位数；四分位数范围（IQR）；388；371 vs 323；362 dynes sec.cm-5；P < .001）明显下降。跨肺梯度 (TPG) 和舒张肺梯度 (DPG) 也显著下降（P < .001 和 P < .001）。心输出量没有明显变化。CpcPH 和 IpcPH 的 MPAP、PVR、TPG、DPG 和肺动脉顺应性 (PAC) 下降幅度相当。有反应者术后的 MPAP、PVR、TPG、DPG 和 PAC 下降幅度并不大：结论：高氧可导致 PH-VHD 两种血液动力学表型的 MPAP 和 PVR 下降。要支持或反驳本研究的结论，需要更大的样本量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.