既往尚无研究探讨症状性射血分数降低的心衰（HFrEF）伴肺动脉高压（PH）时肺血管对运动的反应模式。在第18届美国心力衰竭学会（HFSA）科学年会上，比利时Oost-Limburg医院Frederik H. Verbrugge及同事展示的研究入选40例平均动脉压（...既往尚无研究探讨症状性射血分数降低的心衰（HFrEF）伴肺动脉高压（PH）时肺血管对运动的反应模式。在第18届美国心力衰竭学会（HFSA）科学年会上，比利时Oost-Limburg医院Frederik H. Verbrugge及同事展示的研究入选40例平均动脉压（MAP）＞25 mmHg、肺毛细血管楔压（PCWP）＞15 mmHg、心脏指数＜2.5 L/（min·m2）的40例有症状HFrEF患者，按照试验方案应用硝普钠（SNP）及利尿剂，并滴定剂量使MAP维持在65~75 mmHg、PCWP＜15 mmHg，行仰卧位自行车运动试验。随后逐渐撤用SNP，增加肾素-血管紧张素系统拮抗剂剂量并加用肼屈嗪以维持血液动力学，再次行自行车运动试验。展开更多
It has been suggested that plasma B-type natriuretic peptide(BNP) level may be used as a noninvasive biomarker of the adequacy of long-term heart failure therapy. The effect of contemporary therapy on the relation bet...It has been suggested that plasma B-type natriuretic peptide(BNP) level may be used as a noninvasive biomarker of the adequacy of long-term heart failure therapy. The effect of contemporary therapy on the relation between BNP measured using modern commercially available assays and cardiac filling pressures has not been studied in detail, because most of the original studies predate these developments. The investigators sought to assess the diagnostic accuracy of BNP to identify significantly elevated pulmonary capillary wedge pressure(PCWP) in a group of patients with severe chronic heart failure on treatment. BNP correlated well with PCWP(r=0.50, p< 0.001), but the diagnostic accuracy of the test to identify patients with PCWP >15 mm Hg was only 74%, largely because of poor sensitivity or a large number of false-negative test results. Maximizing medical therapy irrespective of plasma BNP results remains the best approach to managing chronic heart failure.展开更多
国际上,肺动脉高压（Pulmonary arterial hypertension,PAH）被定义为患者静息时平均肺动脉压力≥25 mm Hg（1 mm Hg=0.133 k Pa）,而肺毛细血管楔压〈15 mm Hg,肺血管阻力指数〉3 Wood单位·平方米]。PAH可见于多种儿科疾病,如先...国际上,肺动脉高压（Pulmonary arterial hypertension,PAH）被定义为患者静息时平均肺动脉压力≥25 mm Hg（1 mm Hg=0.133 k Pa）,而肺毛细血管楔压〈15 mm Hg,肺血管阻力指数〉3 Wood单位·平方米]。PAH可见于多种儿科疾病,如先天性心脏病、慢性肺疾病、血液病等,是患儿重要的致死原因之一。先天性心脏病患儿常并存有显著增加的肺血流、肺静脉阻塞、紫绀等,因此在术后最易进展为PAH。展开更多
文摘目的 :探讨右心导管肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)与心脏再同步化治疗(cardiac resynchronization therapy,CRT)慢性心衰疗效的相关性。方法:入选拟行心脏再同步化治疗的慢性心衰患者,术前1周内进行右心导管检查,测定肺毛细血管楔压;根据CRT术后患者心功能变化分成CRT有反应组与无反应组。术后6个月内左室射血分数(LVEF)提高超过5%,纽约心功能分级(NYHA)降低1级或1级以上者定义为CRT有反应;通过受试者工作曲线分析PCWP对CRT反应性的预测价值。应用Kaplan-Meier生存曲线分析不同水平PCWP患者主要心血管不良事件的差异。结果:35例CRT患者中有反应24例,无反应11例;有反应组PCWP(11.9±7.0)mm Hg,无反应组PCWP(21.7±9.1)mm Hg,两组间差异有统计学意义(P=0.006)。以PCWP 12.0 mm Hg为最佳分界点时,Youden指数最大,预测CRT反应性的敏感度为90.9%,特异度为58.3%。相对于PCWP>12.0 mm Hg组,PCWP≤12.0 mm Hg组CRT术后心功能、左室内径和PCWP更佳。Kaplan-Meier生存曲线表明PCWP≤12.0 mm Hg组患者比PCWP>12.0 mm Hg组患者无主要心血管不良事件的生存时间长,但未达到统计学差异(P=0.079)。结论:术前右心导管检测PCWP对CRT反应性有较好的预测价值。术前PCWP低的患者无主要心血管不良事件的生存时间长。
文摘It has been suggested that plasma B-type natriuretic peptide(BNP) level may be used as a noninvasive biomarker of the adequacy of long-term heart failure therapy. The effect of contemporary therapy on the relation between BNP measured using modern commercially available assays and cardiac filling pressures has not been studied in detail, because most of the original studies predate these developments. The investigators sought to assess the diagnostic accuracy of BNP to identify significantly elevated pulmonary capillary wedge pressure(PCWP) in a group of patients with severe chronic heart failure on treatment. BNP correlated well with PCWP(r=0.50, p< 0.001), but the diagnostic accuracy of the test to identify patients with PCWP >15 mm Hg was only 74%, largely because of poor sensitivity or a large number of false-negative test results. Maximizing medical therapy irrespective of plasma BNP results remains the best approach to managing chronic heart failure.
文摘国际上,肺动脉高压（Pulmonary arterial hypertension,PAH）被定义为患者静息时平均肺动脉压力≥25 mm Hg（1 mm Hg=0.133 k Pa）,而肺毛细血管楔压〈15 mm Hg,肺血管阻力指数〉3 Wood单位·平方米]。PAH可见于多种儿科疾病,如先天性心脏病、慢性肺疾病、血液病等,是患儿重要的致死原因之一。先天性心脏病患儿常并存有显著增加的肺血流、肺静脉阻塞、紫绀等,因此在术后最易进展为PAH。
