右室-肺动脉耦合联合右心房压力对肺动脉高压患者的风险评估研究

目的应用右室-肺动脉耦合指标及2015年ESC肺动脉高压诊疗指南推荐指标对肺动脉高压患者进行风险评估。方法对2015年1月至2016年6月武汉亚洲心脏病医院确诊为肺动脉高压患者54例进行回顾性分析,收集患者实验室检查指标、血流动力学指标、心脏磁共振指标,并采用容积法计算基线水平右室-肺动脉耦合指标Ees/Ea。应用Cox风险比例回归及Kaplan-Meier生存分析,综合评估各项指标在肺动脉高压患者生存预后及风险分级方面的临床应用价值。结果右室-肺动脉耦合指标Ees/Ea(HR=6.274,95%CI 1.391~28.298,P=0.017)及右房压压力(RAP)(HR=9.583,95%CI 1.243~33.896,P=0.030)是肺动脉高压患者两年生存预后的主要影响因素。根据中位数进行风险分级,当患者Ees/Ea≤0.74且RAP≥7 mmHg时,其不良预后发生概率是两者均为低风险时(Ees/Ea>0.74且RAP<7)的13倍(HR=13.779,95%CI 10.791~76.012,P<0.05)。结论右室-肺动脉耦合指标Ees/Ea与RAP是肺动脉高压患者生存预后的独立危险因素。基线水平Ees/Ea≤0.74且RAP≥7的肺动脉高压患者出现不良预后的风险更高,值得临床关注。

Risk assessment for patients with pulmonary arterial hypertension by right ventricular-pulmonary arterial coupling combined with right atrial pressure

Objective To evaluate the prognosis of patients with pulmonary arterial hypertension(PAH)based on the right ventricular-pulmonary arterial coupling and ESC guideline recommended parameters. Methods A total of 54 PAH patients confirmed by right heart catheterization were retrospectively reviewed. Collect the patients’ laboratory parameters,hemodynamic parameters and hear MR parameters;volumetric method was used to calculate Ees/Ea at baseline level. Cox proportional regression and Kaplan-Meier survival analysis were used to comprehensively evaluate the predictive value of right ventricular-pulmonary arterial coupling parameter and guideline recommended parameters for prognosis and risk grading. Results Right ventricular-pulmonary arterial coupling parameter Ees/Ea(HR=6.274,95%CI:1.391-28.298,P=0.017)and right atrial pressure(HR=9.583,95%CI:1.243-33.896,P=0.030)were the independent predictive factors of two-year survival for PAH patients. When considering the number of risk factors,PAH patients with Ees/Ea≤0.74 and RAP≥7 had 13 times higher risk than those who were with Ees/Ea>0.74 and RAP<7(HR=13.779,95%CI:10.791-76.012,P<0.05). Conclusions Ees/Ea and RAP are independent predictors of the prognosis for PAH patients. When Ees/Ea≤0.74 and RAP≥7,the PAH patients are more likely to deteriorate.