肺动脉楔压>15 mm Hg的肺高血压病因分析

Etiologic Analysis of Pulmonary Hypertension with Pulmonary Artery Wedge Pressure>15 mm Hg

目的分析肺动脉楔压>15 mm Hg的肺高血压患者的病因。方法入选147例经右心导管诊断的平均肺动脉压≥25 mm Hg和肺动脉楔压>15 mm Hg的肺高血压患者,分析这些患者的临床所患疾病及超声心动图特点。结果在这些患者中,患有先天性心脏病的有18例(12.2%)、心肌病78例(53.1%)、高血压37例(25.2%)、冠心病17例(11.6%)和心房颤动37例(25.2%)。96%的患者有左室射血分数<50%或中度以上左心瓣膜病:左室射血分数<40%的96例(65.3%),左室射血分数40%~49%的13例(8.8%),中度以上左心瓣膜病(主动脉瓣狭窄、主动脉瓣关闭不全、二尖瓣狭窄和二尖瓣关闭不全)的分别有4例(2.7%)、35例(23.8%)、9例(6.1%)和111例(75.5%);最终分析结果表明在147例肺动脉楔压>15 mm Hg的肺高血压患者中,有18例(12.2%)的患者合并有先天性心脏病。结论在入选本研究的肺动脉楔压>15 mm Hg的肺高血压患者中,病因学分析表明部分患者除了有左心疾病,同时合并有先天性心脏病。此外,心脏超声结果表明部分患者既无左室射血分数下降,也无中度以上左心瓣膜疾病。

Objective To analyze the etiology of pulmonary hypertension with pulmonary artery wedge pressure(PAWP)>15 mm Hg.Methods A total 147 patients diagnosed by right heart catheterization with mean pulmonary artery pressure≥25 mm Hg and PAWP>15 mm Hg were enrolled.The clinical characteristic and echocardiographic parameter were further analyzed.Results The etiology is shown as congenital heart disease(18 cases,12.2%),cardiomyopathy(78 cases,53.1%),hypertension(37 cases,25.2%),coronary atherosclerotic disease(17 cases,11.6%)and atrial fibrillation(37 cases,25.2%).96%of these patients were diagnosed with left ventricular ejection fraction(LVEF)<50%or moderate-to-severe left-sided heart valvular disease,including 96 cases(65.3%)with LVEF<40%,13 cases(8.8%)with LVEF 40%~49%.There were 4 cases(2.7%),35 cases(23.8%),9 cases(6.1%)and 111 cases(75.5%)with moderate or above left heart valvular disease(aortic stenosis,aortic insufficiency,mitral stenosis and mitral insufficiency).Final results of our analysis indicate 18 out of 147 patients(12.2%)with pulmnary hypertension of pulmonary wedge pressure>15 mm Hg had congenital heart disease.Conclusion Among the patients with PAWP>15 mm Hg,the etiology analysis shows that a proportion of them with left heart disease simultaneously suffer congenital heart disease.In addition,echocardiographic results showed that some patients had neither decreased LVEF nor more than moderate left ventricular valve disease.