Strain and strain rate echocardiography for evaluation of right ventricular dysfunction in patients with idiopathic pulmonary arterial hypertension

Optimizing the non-invasive imaging of right ventricular (RV) function is of increasing interest for therapy monitoring and risk stratification in patients with idiopathic pulmonary hypertension (IPAH). Therefore, this study evaluated strain and strain rate echocardiography as a tool for comprehensive assessment of RV function and disease severity in IPAH patients. In 30 IPAH patients [WHO functional classes II–IV; mean pulmonary artery pressure (mPAP) 48.8 ± 12.5 mmHg; pulmonary vascular resistance (PVR) 7.9 ± 5.3 Wood units] and in 10 matched healthy control subjects’ two-dimensional echocardiography, 6-MWD and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were obtained. In IPAH patients when compared with controls, RV systolic strain (−18.8 ± 4.3 vs. −34.5 ± 3.8%, p = 0.0016) and strain rate (−1.6 ± 0.6 vs. −2.7 ± 0.5 s⁻¹, p = 0.018) were significantly altered and correlated significantly with elevated NT-proBNP levels (r = 0.73 and r = 0.62; p < 0.001, respectively) and reduced 6-MWD (r = −0.76 and r = −0.81; p < 0.001). In IPAH patients, reduced strain correlated with both mPAP (r = 0.61, p = 0.01 for strain; and r = 0.55, p = 0.04 for strain rate, respectively), and PVR (r = 0.84, p < 0.001 for strain; and r = 0.67, p < 0.001 for strain rate, respectively). This study gives first comprehensive evidence that strain echocardiography allows accurate non-invasive assessment of RV function and disease severity in patients with IPAH.     

组织速度成像评估特发性肺动脉高压患者右心室心肌非同步运动

目的 探讨定量组织速度成像评估特发性肺动脉高压（IPAH）患者右心室非同步运动的意义。方法 选择26例IPAH患者和25例正常人，常规测量、计算右心室结构参数（游离壁厚度、舒张末期面积和收缩末期面积、面积变化率）和功能参数[游离壁三尖瓣环收缩期峰速（Sa）、舒张早期峰速（Ea）、舒张晚期峰速、Tei指数]。离线分析右心室3个壁基底段和中间段组织速度曲线，测量QRS波起点至6节段Sa、Ea时限（TQs、TQr）。计算同一节段3个壁间TQ-S、TQ-E最大差值（Inter-△TQ-S、Inter-△TQ-E）、同一壁内2个节段间TQ-S、TQ-E最大差值（Intra-△TQ-S、Intra-△TQ-F）及6节段间TQ-S、TQE最大差值（Max-ATQ-s、Max-△TQ-E）。结果 与正常人相比，IPAH患者Inter-△TQ-S、Inter-△TQ-E、Max-△TQ-S、Max-△TQ-E明显延长（P〈0．001），Intra-△TQ-S、Intra-△TQ-E略延长（P〉0．05）。IPAH患者Max-△TQ-S、Max-ATQ-E与右心室结构参数和功能参数均有良好相关性。结论 IPAH右心室内存在非同步运动，且与右心室结构和功能关系密切。     

超声斑点追踪成像技术评价肺动脉高压患者右心室功能

目的 应用超声斑点追踪成像技术评价肺动脉高压患者的右心室功能及其影响因素.方法 应用超声斑点追踪成像技术测量42例肺动脉高压患者及31例正常对照组的右心室游离壁基底段、中间段及心尖段收缩峰值速度(V)、收缩峰值应变(ε)、收缩峰值应变率(SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa),对结果 进行组间比较,并分析影响肺动脉高压患者右心室功能的指标.结果 肺动脉高压患者各节段ε、SRs、SRe、SRa均较对照组均显著减低(P均<0.05),而v与对照组无明显差异,肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右心室收缩功能的重要因素(r=-0.292～-0.511,r=-0.276～-0.489,P均<0.05),三尖瓣环收缩峰值速度与肺动脉高压患者右心室游离壁基底段V、ε、SRs有良好的相关性(r=0.480～0.622,P<0.01).结论 肺动脉高压患者右心室功能减低,超声斑点追踪成像技术可准确、客观地评价右心室功能.     

Cardiac magnetic resonance-derived right ventricular outflow tract systolic flow acceleration: a novel index of right ventricular function and prognosis in patients with pulmonary arterial hypertension

To validate the right ventricular outflow tract systolic flow acceleration (RVOT_ACC; peak flow velocity/time-to-peak velocity) measured by phase-contrast (PC)—cardiovascular magnetic resonance (CMR) as a novel index of right ventricular (RV) function, and to investigate its clinical implications in patients with pulmonary arterial hypertension (PAH). Thirty (38 % male, 43 ± 15 years old) out of 55 consecutive patients who were initially diagnosed with PAH at the referral center were prospectively enrolled between March 2009 and July 2010 and were followed for PAH-related cardiovascular events for 2 years. The invasively measured maximum dP/dt (dP/dt_max) was used as an index of RV contractility. The PC-CMR-derived RVOT_ACC was compared with well-known prognostic parameters. The PC-CMR-derived RVOT_ACC correlated strongly with the dP/dt_max and estimated RV function more accurately than the CMR-derived RV ejection fraction. The CMR-derived RVOT_ACC level (HR = 0.87, 95 % CI 0.78–0.98, p = 0.038) could be another powerful prognostic index compared with the functional capacity (hazard ratio [HR] = 0.88, 95 % confidence interval [CI] 0.78–0.97, p = 0.035) and REVEAL Registry risk score (HR = 0.83, CI 0.56–0.95, p = 0.012). Furthermore, receiver-operating characteristic analysis identified ≥0.4 m/s² as the optimal RVOT_ACC cut-off for predicting subsequent cardiovascular events. PC-CMR-derived RVOT_ACC is a promising non-invasively measured index of RV function and prognosis in patients with PAH.     

Pimobendan improves right ventricular myocardial contraction and attenuates pulmonary arterial hypertension in rats with monocrotaline-induced pulmonary arterial hypertension

Purpose

The present study aimed to evaluate the therapeutic effect of pimobendan treatment for pulmonary hypertension (PH) in rats administered monocrotaline (MCT).

Methods

Fifty-four 12-week-old male Sprague–Dawley rats were injected with monocrotaline or saline solution. Serial echocardiography and right ventricular systolic pressure (RVSP) measurement via a cardiac catheter were performed. After injection of MCT, rats received oral pimobendan (MCT/pimobendan group) or no treatment (MCT group) until undergoing echocardiography and cardiac catheter insertion.

Results

Right ventricular systolic pressure in the MCT/pimobendan group was lower than that in the MCT group at 6 weeks. Right ventricle free wall (RVFW) myocardial systolic velocity (Sm) in the MCT group showed a reduction compared with the saline group at 2 weeks. RVFW Sm in the MCT/pimobendan group was preserved as compared with the saline group at 2 weeks. RVFW Tei index in the MCT/pimobendan group showed a reduction compared with the saline group and the MCT group at 2 weeks. Echocardiography in the MCT/pimobendan group showed improvement compared with MCT rats.

Conclusions

Both a reduction in RVSP and improvement in myocardial contraction were demonstrated with administration of pimobendan in rats with PH induced by MCT. Echocardiography evaluation of systolic function seems to be useful for monitoring excess administration of pimobendan.     

应变成像技术对肺动脉高压患者右心室非同步运动的研究

目的 探讨应变成像技术评价肺动脉高压患者右室非同步运动的临床意义.方法 60例肺动脉高压患者依据肺动脉收缩压(PASP)分为轻、中、重三组;20例健康志愿者为对照组.测量并计算右心室参数,右心室结构参数包括右室横径/左室横径(RVTD/LVTD)、右室舒张末面积(RVEDA)、右室收缩末面积(RVESA);功能参数包括右室面积变化率(RVFAC)、Tei指数;右心室应变参数包括右室不同室壁节段的收缩期应变峰值(PST)的最大差值(Max-ΔPST)、应变达峰时间(T_(Q-S))的最大差值(Max-ΔT_(Q-S)).结果 与对照组比较,肺动脉高压组Max-ΔT_(Q-S)和Max-ΔPST明显增大(P<0.01).Max-ΔT_(Q-S)与PASP及右心室结构和功能参数均有高度相关性(P<0.01).Max-ΔPST与PASP及Tei指数有一定的相关性(P<0.05,P<0.01).结论 肺动脉高压患者存在右室非同步运动,在轻度肺动脉高压组中即有明显改变,且与右心室结构及功能参数有一定的相关性,提示应变成像技术测量右室非同步参数可用于早期评价肺动脉高压患者的右心室功能.     

组织多普勒成像技术评价肺动脉高压患者右心室收缩及舒张功能

目的:应用多普勒组织成像(DTI)技术评价肺高压患者右心室功能的变化。方法:应用DTI技术对3组不同程度肺高压患者的三尖瓣环运动频谱进行分析, 测量三尖瓣前叶、后叶及隔叶瓣环的收缩期峰值速率(Sa)、舒张早期峰值速率(Ea)及舒张晚期峰值速率(Aa),对3组患者各参数进行比较,并与正常组对照分析。结果:肺动脉高压组较正常组诸参数有显著差异:肺高压Ⅱ组及Ⅲ组,三尖瓣环前叶、隔叶Sa较对照组减小(P<0.05)。肺高压Ⅲ组前叶Sa较Ⅰ组亦有统计学差异(P<0.05)。Ⅲ组后叶瓣环Sa较对照组减小(P<0.05)。肺高压Ⅲ组,前叶瓣环Ea较对照组减小(P<0.05),隔叶Ea值较对照组与Ⅰ组减小(P<0.05),隔叶和后叶瓣环Aa肺高压Ⅲ组均较对照组减低(P<0.05)。肺高压Ⅱ组,Ⅲ组前叶瓣环Ea/Aa均较对照组减小(P<0.05),隔叶、后叶Ea/Aa值Ⅲ组较对照组减小(P<0.05)。结论:中至重度肺动脉高压能引起右心室舒缩功能的减低,收缩功能出现损害早于舒张功能。     

Osteopontin predicts adverse right ventricular remodelling and dysfunction in pulmonary hypertension

Eur J Clin Invest 2012; 42 (9): 933-942 ABSTRACT: Background Osteopontin (OPN) was found upregulated in several heart failure models and appears to play an important role in myocardial remodelling. As we have previously demonstrated that OPN predicts mortality in patients with pulmonary hypertension (PH), we now evaluated whether OPN also predicts adverse right ventricular (RV) remodelling and dysfunction in PH. Methods We prospectively included 71 patients with PH of different etiology in this study. OPN plasma level were determined by ELISA and assessed for correlation with RV dilatation and dysfunction determined by echocardiography. Results OPN plasma values significantly correlated with RV end-diastolic diameter, Tricuspid Annular Plane Systolic Excursion (TAPSE) and Tricuspid Annular Systolic Velocity (TASV) (r?=?0·43, P?=?0·0002; r?=?-0·46, P?=?0·0006; r?=?-0·31, P?=?0·02). Furthermore, stratification of our study population according to RV end-diastolic diameter and RV dysfunction revealed that patients with enlarged and functionally impaired RV's display higher OPN levels (956?ng/mL vs. 628?ng/mL, P?=?0·0005; 1108?ng/mL vs. 792?ng/mL; P?=?0·02). Next, we determined OPN cut-off values for the detection of RV remodelling and dysfunction by receiver operating curve analyses and further stratified these parameters in a multivariate analysis. Here, OPN emerged as an independent predictor of RV dilatation and dysfunction. Finally, we demonstrate synergism of OPN and NT-proBNP in the prediction of RV dilatation and dysfunction by calculation of the Rothman Synergy Index. Conclusion In summary, OPN predicts adverse RV remodelling and dysfunction in PH. Together with our previously published data regarding OPN's value for the prognostication of death in PH, we believe that OPN can improve risk stratification in patients with PH beyond current assessment standards.     

斑点追踪显像评价肺动脉高压患者右心室整体纵向功能的临床研究

目的 应用斑点追踪显像技术评价肺动脉高压患者右心室整体纵向功能.方法 正常对照组31例;肺动脉高压患者42例,根据肺动脉收缩压程度将其分为轻度(17例)、中度(15例)、重度(10例)三组.获取心尖四腔观,应用二维超声斑点追踪显像技术测量并比较各组右室整体纵向收缩期峰值应变(GLS)、收缩期峰值应变率(GLSRs)、舒张早期峰值应变率(GLSRe)、舒张晚期峰值应变率(GLSRa),分析影响肺动脉高压患者右室整体纵向功能的指标.结果 轻、中、重度肺动脉高压患者右室GLS、GLSRs、GLSRe、GLSRa均较对照组显著减低,差异有统计学意义(均P<0.05),且重度肺动脉高压患者右室GLS较轻度者显著减低,差异有统计学意义(P<0.05),轻、中、重度肺动脉高压患者之间右室GLSRs、GLSRe、GLSRa差异无统计学意义(P>0.05),肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右室整体纵向收缩功能的决定因素(r=-0.466～-0.549,r=-0.403～-0.425,均P<0.05),三尖瓣环收缩峰值速度与肺动脉高压患者右室GLS、GLSRs有良好的相关性(r=0.556～0.585,P<0.001).结论 肺动脉高压患者的右室整体功能减低,斑点追踪显像技术可准确、客观地评价右室整体纵向功能.     

超声新技术在评估肺高血压患者右心功能中的研究进展

右心衰竭是肺高血压患者共同的死因和结局。如何应用超声对右心功能做出准确评价,是肺高血压患者病情分级、治疗监测和预后评估的关键。由于右室解剖、生理学复杂,应用传统超声准确评价右心功能非常困难。近年来涌现出的超声新技术克服了传统超声在评估右心功能中的不足,使得对右心结构和功能做出准确评价成为可能。本文就各种超声新技术在评价肺高血压患者右心功能中的研究进展做一综述。     

超声二维应变成像与组织多普勒技术评价右心室纵向收缩功能的对比研究

目的 应用超声二维应变成像和组织多普勒(TDI)技术评价正常人及肺动脉高压患者右室纵向收缩功能,探讨二维应变定量评价心肌纵向收缩功能的应用价值.方法 肺动脉高压患者42例(PAH组),正常人31例(对照组),应用二维应变成像与TDI于心尖四腔观分别测量并计录右室游离壁基底段、中间段及心尖段纵向收缩峰值速度(V)、应变(ε)、应变率(SRS).并对两种测量方法 进行比较.结果 ①与对照组比较,PAH组TDI检测显示右室游离壁中间段ε、SRS值减低,差异均有统计学意义(P<0.05),基底段及心尖段ε、SRS值二组间差异无统计学意义(P>0.05);PAH组二维应变显示右室游离壁各节段ε、SRS测值均显著减低,差异有统计学意义(P均<0.05),而TDI及二维应变右室游离壁各节段V值差异无统计学意义(P>0.05).②与TDI测值比较,对照组内右室游离壁二维应变测值(V、ε、SRS)基底段、心尖段差异有统计学意义(P<0.05),中间段测值差异无统计学意义(P>0.05);PAH组内右室游离壁二维应变测值(V、ε、SRS)心尖段差异有统计学意义,基底段、中间段测值差异无统计学意义.③PAH组中两种测量方法 相关性良好(r=0.406～0.760,P均<0.05).结论 肺动脉高压患者的右室纵向收缩功能减低,二维应变可更准确、客观地评价右室长轴收缩功能.     

超声新技术评估肺动脉高压患者右心功能研究进展

右心衰竭是肺动脉高压患者共同的死因和结局。如何应用超声准确评价右心功能,是对肺动脉高压患者进行病情分级、治疗监测和预后评估的关键。由于右心室的解剖、生理学复杂,应用传统超声较难准确评价右心功能。近年来涌现出的超声新技术克服了传统超声的不足,使得对右心结构和功能做出准确评价成为可能。本文就各种超声新技术评价肺动脉高压患者右心功能的研究进展进行综述。     

Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile

Regional right ventricular (RV) dysfunction (RRVD) is an echocardiographic feature in acute pulmonary embolism (PE), primarily reported in patients with moderate-to-severe RV dysfunction. This study investigated the clinical importance of RRVD by assessing its relationship with clot burden and biomarkers. We identified consecutive patients admitted to the emergency department between 1999 and 2014 who underwent computed tomographic angiography, echocardiography, and biomarker testing (troponin and NT-proBNP) for suspected acute PE. RRVD was defined as normal excursion of the apex contrasting with hypokinesis of the mid-free wall segment. RV assessment included measurements of ventricular dimensions, fractional area change, free-wall longitudinal strain and tricuspid annular plane systolic excursion. Clot burden was assessed using the modified Miller score. Of 82 patients identified, 51 had acute PE (mean age 66 ± 17 years, 43 % male). No patient had RV myocardial infarction. RRVD was present in 41 % of PEs and absent in all patients without PE. Among patients with PE, 86 % of patients with RRVD had central or multi-lobar PE. Patients with RRVD had higher prevalence of moderate-to-severe RV dilation (81 vs. 30 %, p < 0.01) and dysfunction (86 vs. 23 %, p < 0.01). There was a strong trend for higher troponin level in PE patients with RRVD (38 vs. 13 % in PE patients without RRVD, p = 0.08), while there was no significant difference for NT-proBNP (67 vs. 73 %, p = 0.88). RRVD showed good concordance between readers (87 %). RRVD is associated with an increased clot burden in acute PE and is more prevalent among patients with moderate-to-severe RV enlargement and dysfunction.     

The strain-encoded (SENC) MR imaging for detection of global right ventricular dysfunction in pulmonary hypertension

The aim of this study was to explore whether the regional peak longitudinal (LS) and circumferential strains (CS) at the right ventricular (RV) free wall could be used to identify global RV dysfunction in relation to RV ejection fraction (RVEF) and plasma concentration of brain natriuretic peptide (BNP) in pulmonary hypertension (PH). A total of 37 consecutive patients diagnosed with PH and 13 healthy control subjects were included. Fast strain encoded and routine cine MRI was performed. The LS and CS at three RV levels were quantified and their relations with RVEF and BNP were investigated. Receiver operating characteristic (ROC) analysis was employed to assess the diagnostic utility of strain encoded MRI for the detection of low RVEF. Significant correlations with LS were observed for RVEF and BNP. Compared to CS, LS showed better correlation with RVEF. The mid-ventricular level of RV was the most sensitive site for evaluation of RV dysfunction. According to our ROC analysis, LS showed higher sensitivity and specificity to detect low RVEF. Compared to CS, LS showed stronger correlations with RVEF and BNP and could be a good detector of RV dysfunction in PH.     

Plasma exosomal miR-596: a novel biomarker predicts survival in patients with idiopathic pulmonary artery hypertension

ObjectiveTo determine if plasma exosomal microRNAs (miRNAs) can predict survival in patients with idiopathic pulmonary arterial hypertension (IPAH).MethodsThe study enrolled patients with IPAH that underwent right heart catheterization. Plasma was collected and exosomal miRNAs were extracted. Exosomes were evaluated using transmission electron microscopy, Western blot analysis and particle size distribution analysis. MiRNAs were evaluated using a miRNA microarray and validated using real-time polymerase chain reaction.ResultsThis study included 12 patients with IPAH in the study group and 48 patients with IPAH in the validation group. The mean ± SD follow-up duration was 60.3 ± 35.4 months in the overall cohort. The levels of miR-596 were higher in the nonsurvivors compared with the survivors. The levels of miR-596 significantly correlated with survival time, mean right atrial pressure, pulmonary vascular resistance (PVR) and cardiac index. High levels of miR-596 and PVR were significantly associated with poor overall survival. Multivariate analysis demonstrated that exosomal miR-596 (hazard ratio [HR] = 2.119; 95% confidence interval [CI] 1.402, 3.203) and PVR (HR = 1.146; 95% CI 1.010, 1.300) were independent predictors of survival.ConclusionsHigh levels of plasma exosomal miR-596 were significantly associated with disease severity and poor prognosis of patients with IPAH.     

Impact of right ventricular dyssynchrony on left ventricular performance in patients with pulmonary hypertension

Pulmonary hypertension has been associated with right ventricular (RV) dyssynchrony which may induce left ventricular (LV) dysfunction and dyssynchrony through ventricular interdependence. The present study evaluated the influence of RV dyssynchrony on LV performance in patients with pulmonary hypertension. One hundred and seven patients with pulmonary hypertension (age 63 ± 14 years, systolic pulmonary arterial pressure 60 ± 19 mmHg) and LV ejection fraction (EF) >35 % were evaluated. Ventricular dyssynchrony was assessed with speckle tracking echocardiography and defined as the standard deviation of the time to peak longitudinal strain of six segments of the RV (RV-SD) and the LV (LV-SD) in the apical 4-chamber view. Mean RV-SD and LV-SD assessed with longitudinal strain speckle tracking echocardiography were 51 ± 28 and 47 ± 21 ms, respectively. The patient population was divided according to the median RV-SD value of 49 ms. Patients with RV-SD ≥49 ms had significantly worse NYHA functional class (2.7 ± 0.7 vs. 2.3 ± 0.7, p = 0.004), RV function (tricuspid annular plane systolic excursion: 16 ± 4 vs. 19 ± 4 mm, p < 0.001), LVEF (50 ± 10 vs. 55 ± 8 %, p = 0.001), and larger LV-SD (57 ± 18 vs. 36 ± 18 ms, p < 0.001). RV-SD significantly correlated with LV-SD (r = 0.55, p < 0.001) and LVEF (r = ?0.23, p = 0.02). Multiple linear regression analysis showed an independent association between RV-SD and LV-SD (β = 0.35, 95 %CI 0.21–0.49, p < 0.001). RV dyssynchrony is significantly associated with LV dyssynchrony and reduced LVEF in patients with pulmonary hypertension.     

超声二维应变成像评价肺动脉高压患者右心室纵向收缩功能

目的 应用超声二维应变成像技术评价肺动脉高压患者右心室收缩功能.方法 正常对照组31例;肺动脉高压患者42例,根据肺动脉收缩压程度将其分为轻度(17例)、中度(15例)、重度(10例)三组.获取心尖四腔观,应用二维应变技术测量并记录右室整体及游离壁基底段、中间段、心尖段纵向收缩峰值应变(ε).对三组应变参数进行比较,并分析影响肺动脉高压患者右室功能的指标.结果 轻、中、重度肺动脉高压患者右室整体ε及游离壁各节段ε较对照组均显著减低,差异有统计学意义(P均＜0.05),且重度肺动脉高压右心室整体ε及游离壁各节段ε较轻度组显著减低,差异有统计学意义(P＜0.001).肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右室功能的决定因素(γ1=-0.491～-0.641,γ2=-0.403～-0.489,P均＜0.05),三尖瓣环收缩峰值速度与肺动脉高压右室整体ε及游离壁各节段ε有良好的相关性(γ=0.463～0.587,P＜0.001).结论 肺动脉高压患者的右室功能减低,超声二维应变成像可准确、客观地评价右室长轴收缩功能.     

Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS

Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI₂, 12.5–35.0 ng·kg^–1·min^–1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI₂ infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI₂ reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p<0.01). The cardiac index (CI) increased from 4.2 to 5.81·min^–1·m^–2 (p<0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg·min·m²·1^–1,p<0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%,p<0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r=0.789, % RVEF=–2.11·PVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p<0.05) the arterial PO₂ remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min^–1·m^–2 (p<0.01). We conclude that short term infusions of PGI₂ increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI₂ may be useful to lower pulmonary artery pressure in ARDS.Supported by the Deutsche Forschungsgemeinschaft (grant Fa 139/2-2)     

特发性肺动脉高压患者营养风险与运动耐量间相关性的研究

目的：探讨特发性肺动脉高压患者（idiopathic pulmonary arterial hypertension, IPAH）营养风险与运动耐量间的关系。方法：根据营养风险筛查2002标准（Nutritional Risk Screening 2002, NRS-2002）（以下简称NRS）, 对96例IPAH患者进行营养风险评估, 并根据评分结果分为有营养风险组（n=46）及无营养风险组（n=50）, 2组分别进行血气分析、肺功能检测及心肺运动试验,比较2组间的差异。结果：IPAH有营养风险组与无营养风险组间的性别、年龄、身高及血气分析结果差异均无统计学意义（P均>0.05）, 而有营养风险组患者的体重及体质量指数显著低于无营养风险组（P<0.01）。肺功能检测, 有营养风险组的用力肺活量（forced vital capacity, FVC）、第一秒用力呼气容积（forced expiratory volume in one second, FEV₁）、FVC占预计值百分比（FVC%pred）、FEV₁占预计值百分比（FEV₁%pred）、一氧化碳弥散量（diffusing capacity for carbon monoxide, DL_CO）、DL_CO占预计值百分比（DL_CO%pred）均低于无营养风险组（P均<0.05）, 而2组间其他指标[一秒率（FEV₁/FVC）、深吸气量、肺总量、残气量、残总比（残气量/肺总量比值）]差异无统计学意义（P均>0.05）。心肺运动试验检查, 有营养风险组的峰值功率、峰值摄氧量、峰值通气量、峰值公斤摄氧量、峰值摄氧量占预计值百分比均低于无营养风险组（P 均<0.05）, 而2组间的峰值氧脉搏差异无统计学意义（P>0.05）。96例IPAH患者的NRS评分与峰值功率、峰值摄氧量呈显著负相关（r=-0.335和-0.342, P均<0.01）, NRS评分与峰值公斤摄氧量呈负相关（r=-0.213, P<0.05）。结论：有营养风险的IPAH患者的肺通气功能及弥散功能降低更显著, 运动耐量下降更明显,而NRS评分可反映其运动耐量。