Sinan Osman, Natasha R Girdharry, Elizabeth Karvasarski, Robert F Bentley, Stephen P Wright, Nadia Sharif, Micheal McInnis, John T Granton, Marc dePerrot, Susanna Mak
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Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty-five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (<i>p</i> < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance-compliance time product at rest. 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引用次数: 0
摘要
慢性血栓栓塞性肺病(CTEPD)的特点是肺动脉(PA)中有组织的非溶解性血栓。在伴有肺动脉高压(PH)的慢性血栓栓塞性肺疾病(CTEPD)中,早期波反射会导致搏动性后负荷异常和肺动脉压力升高。我们假设,在右心导管检查(RHC)过程中,运动会比无 PH 的 CTEPD 患者的阻力性升高更频繁地引起搏动性血管后负荷升高。此外,还对肺静脉和肺动脉瓣血流动力学的相互依存生理学进行了评估。对连续接受运动 RHC 的无 PH CTEPD 患者(静息时平均 PA 压力≤20 mmHg)进行了鉴定。肺血管后负荷的潜在阻力性和搏动性异常分别定义为运动时平均 PA 压力/心输出量 >3 WU,以及 PA 脉搏压力与 PA 楔压(PA PP/PAWP)之比 >2.5。研究分析了 45 名无 PH 的 CTEPD 患者(29% 女性,53 ± 14 岁)。运动时,19 名患者无异常(ExNOR),26 名患者肺血管后负荷的搏动性(20)、阻力性(2)或两者(4)均有异常(ExABN)。运动引起的搏动性后负荷升高(53%)比阻力性后负荷升高(13%)更常见(p
Exercise and pulsatile pulmonary vascular loading in chronic thromboembolic pulmonary disease.
Chronic thromboembolic pulmonary disease (CTEPD) is characterized by organized nonresolving thrombi in pulmonary arteries (PA). In CTEPD with pulmonary hypertension (PH), chronic thromboembolic PH (CTEPH), early wave reflection results in abnormalities of pulsatile afterload and augmented PA pressures. We hypothesized that exercise during right heart catheterization (RHC) would elicit more frequent elevations of pulsatile vascular afterload than resistive elevations in patients with CTEPD without PH. The interdependent physiology of pulmonary venous and PA hemodynamics was also evaluated. Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty-five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (p < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance-compliance time product at rest. The physiological relationship between changes in PA pressures relative to PAWP was disrupted in the ExABN group. In CTEPD without PH, exercise RHC revealed latent pulmonary vascular afterload elevations in 58% of patients with more frequent augmentation of pulsatile than resistive pulmonary vascular afterload.
期刊介绍:
Pulmonary Circulation''s main goal is to encourage basic, translational, and clinical research by investigators, physician-scientists, and clinicans, in the hope of increasing survival rates for pulmonary hypertension and other pulmonary vascular diseases worldwide, and developing new therapeutic approaches for the diseases. Freely available online, Pulmonary Circulation allows diverse knowledge of research, techniques, and case studies to reach a wide readership of specialists in order to improve patient care and treatment outcomes.