高频前肺动脉高压（HFpEF）预检概率对肺动脉高压预后的临床影响

IF 21.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American College of Cardiology Pub Date : 2024-11-26 DOI:10.1016/j.jacc.2024.08.061

Yogesh N.V. Reddy MBBS, MSc , Robert P. Frantz MD , Paul M. Hassoun MD , Anna R. Hemnes MD , Evelyn Horn MD , Jane A. Leopold MD , Franz Rischard MD , Erika B. Rosenzweig MD , Nicholas S. Hill MD , Serpil C. Erzurum MD , Gerald J. Beck PhD , J. Emanuel Finet MD , Christine L. Jellis MD , Stephen C. Mathai MD , W.H. Wilson Tang MD , Barry A. Borlaug MD

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引用次数: 0

摘要

背景1组肺动脉高压（PH）患者和射血分数保留型心力衰竭（HFpEF）危险因素患者对肺血管扩张剂治疗的反应较差。本研究的目的是根据 HFpEF 的预测概率，比较 1 类 PH 患者的运动能力、心脏功能和血液动力学对刺激性操作的反应。方法在多中心 PVDOMICS（通过肺血管疾病表型重新定义肺动脉高压）研究中招募的第 1 组 PH 患者中，根据年龄、体重指数和心房颤动病史，使用经过验证的 HFpEF-ABA 算法确定 HFpEF 的预测概率。结果在424名第1组PH患者中，54%（n=228）为中度HFpEF概率，15%（n=64）为高度HFpEF概率。静息 PCWP 随 HFpEF 可能性的增加而逐渐升高（P <0.0001），第 1 组 PH 和 HFpEF 可能性高的患者在一氧化氮、液体挑战和运动时 PCWP 升高幅度最大（P <0.001），这些变化与无肺血管疾病的 HFpEF 患者（n = 194）相当，但低于合并毛细血管前和毛细血管后 PH 的 HFpEF 患者。与低度或中度 HFpEF 患者相比，PH 值为 1 且 HFpEF 可能性高的患者的左心室/心房大小、舒张功能、生活质量、6 分钟步行距离和峰值 VO2 最不正常（均为 P < 0.0001）。结论对第 1 组 PH 患者的 HFpEF 检测前概率进行量化，可识别出动态 PCWP 反应较差的亚临床左心疾病患者，这些患者的功能状态、生活质量和存活率都较差。有必要对这一 PH 1 组亚群进行进一步研究，以确定 PH 疗法是否有效、安全，以及 HFpEF 特异性疗法是否能改善功能状态和预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Clinical Implications of Pretest Probability of HFpEF on Outcomes in Precapillary Pulmonary Hypertension

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Clinical Implications of Pretest Probability of HFpEF on Outcomes in Precapillary Pulmonary Hypertension

Background

Patients with group 1 pulmonary hypertension (PH) and risk factors for heart failure with preserved ejection fraction (HFpEF) demonstrate worse response to pulmonary vasodilator therapy. The mechanisms and optimal diagnostic approach to identify such patients remain unclear.

Objectives

The purpose of this study was to compare exercise capacity, cardiac function, and hemodynamic responses to provocative maneuvers among patients with group 1 PH based upon pretest probability of HFpEF.

Methods

Pretest probability for HFpEF was determined using the validated HFpEF-ABA algorithm based on age, body mass index, and history of atrial fibrillation among group 1 PH patients recruited to the multicenter PVDOMICS (Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics) study. Functional capacity, quality of life, and dynamic pulmonary capillary wedge pressure (PCWP) responses were compared between those with low (<25%), intermediate (25%-74%), and high (≥75%) ABA score-based HFpEF probability.

Results

Among 424 patients with group 1 PH, 54% (n = 228) had intermediate HFpEF probability and 15% (n = 64) had high HFpEF probability. Resting PCWP increased progressively with higher HFpEF probability (P < 0.0001), and patients with group 1 PH and high HFpEF probability had the greatest increases in PCWP with nitric oxide, fluid challenge, and exercise (P < 0.001 for all), changes that were comparable to patients with HFpEF with no pulmonary vascular disease (n = 194), but lower than those with HFpEF and combined precapillary and postcapillary PH. Left ventricular/atrial size, diastolic function, quality of life, 6-minute walk distance, and peak VO₂ were most abnormal in patients with group 1 PH and high HFpEF probability compared with those with low or intermediate HFpEF probability (P < 0.0001 for all). Increasing HFpEF probability in group 1 PH was associated with greater risk of death (HR per decile of HFpEF probability 1.09; 95% CI: 1.05-1.13; P < 0.0001).

Conclusions

Quantifying pretest probability for HFpEF in patients with group 1 PH identifies a subset of patients with worse dynamic PCWP response indicative of subclinical left heart disease, with poorer functional status, quality of life, and survival. Further study in this group 1 PH subgroup is indicated to determine whether PH therapies are effective and safe, and also whether HFpEF-specific therapies can improve functional status and outcomes.

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来源期刊

Journal of the American College of Cardiology 医学-心血管系统

CiteScore

42.70

自引率

3.30%

发文量

5097

审稿时长

2-4 weeks

期刊介绍： The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints. Content Profile: -Original Investigations -JACC State-of-the-Art Reviews -JACC Review Topics of the Week -Guidelines & Clinical Documents -JACC Guideline Comparisons -JACC Scientific Expert Panels -Cardiovascular Medicine & Society -Editorial Comments (accompanying every Original Investigation) -Research Letters -Fellows-in-Training/Early Career Professional Pages -Editor’s Pages from the Editor-in-Chief or other invited thought leaders