肺动脉高压和心力衰竭:右心室-肺动脉耦合的备选指标

V. A. Mareyeva, A. A. Klimenko, N. A. Shostak
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引用次数: 0

摘要

肺动脉高压是一种严重的心血管疾病,常并发心力衰竭(HF)。肺动脉压过高会增加右心室后负荷并逐渐导致功能障碍,与左心室射血分数无关,这与不良结局相关。在这方面,应更加重视确定右心室状况。目前,为了评估肺动脉高压合并心衰患者的右心功能,越来越多地使用右心室(RV)-肺动脉(PA)耦合。计算该参数的常规公式为三尖瓣环平面收缩偏移(TAPSE)与肺动脉收缩压(PASP)之比。该指数已被证明是不良后果的有力预测指标。但这种计算方法有一定的局限性,可能导致误差。在预后评估过程中,排除或尽量减少任何可能的不准确性是极其重要的,这就是为什么最近发表了关于替代RV-PA计算选项的新研究。讨论了在TAPSE和PASP评估中可能出现的问题,以及肺动脉高压和心力衰竭患者右心功能评估的修改方法。讨论了新的RV-PA替代指标的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pulmonary hypertension and heart failure: alternative indexes of right ventricular-pulmonary artery coupling
Pulmonary hypertension is a serious cardiovascular pathology, often complicating the course of heart failure (HF). Excessive pulmonary artery pressure increases right ventricular afterload and progressively leads to dysfunction, which is associated with adverse outcomes regardless of left ventricular ejection fraction. In this regard, more attention should be paid to determining the right ventricular condition. Currently, in order to assess the right heart function in patients with pulmonary hypertension and HF, the right ventricular (RV)-pulmonary arterial (PA) coupling, is increasingly being used. The conventional formula to calculate this parameter is the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). This index has proven to be a powerful predictor of adverse outcomes. But this calculation method has a number of limitations and can lead to errors. It is extremely important to exclude or minimize any possible inaccuracies during prognostic assessment, which is why new researches of alternative RV-PA calculation options have been recently published. Such things as problems that can occur during TAPSE and PASP evaluation, ways of modifying the assessment of right heart’s functioning in patients with pulmonary hypertension and heart failure have been addressed. The value of new RV-PA alternative «surrogate» indexes has been discussed.
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