肺动脉高压患者压力-容积关系分析与纽约心脏病协会心功能分级的相关性  

Assessment of pressure-volume loop in patients with pulmonary hypertension and the correlation with New York Heart Function Classification

作　　者：张长东[1] 肖书娜[2] 尚小珂[3] 卢蓉[4] 王利军 田军[3] 董念国[3] 柳梅[4] 刘义华 李飞[3] 陈澍[3] 孙永丰[3] 李庚[3] ZHANG Chang-dong XIAO Shu-na SHANG Xiao-ke LU Rong WANG Li-jun TIAN Jun DONG Nian-guo LIU Mei LIU Yi-hua LI Fei CHEN Shu SUN Yong-feng LI Geng(Department of cardiac surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Chin)

机构地区：[1]武汉亚洲心脏病医院心外科,湖北武汉430022 [2]湖北省妇幼保健院ICU [3]华中科技大学同济医学院附属协和医院心脏大血管外科 [4]武汉市第一医院ICU

出　　处：《中国介入心脏病学杂志》2017年第9期512-519,共8页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨肺动脉高压患者的压力-容积相关参数与不同纽约心脏病协会(NYHA)心功能分级间的相关性。方法纳入2015年4月至2016年6月于武汉亚洲心脏病医院就诊的肺动脉高压患者36例,通过股静脉入径右心导管记录右心房压力曲线、右心室压力曲线、肺动脉压力曲线及不同部位血氧饱和度,同期行心脏磁共振成像(MRI)检查获得单个心动周期下的右心室容积,并使用Mass软件测量连续的右心室容积,再进一步获得右心室压力-容积环参数的计算结果。根据NYHA心功能分级进行分组,即NYHA心功能Ⅰ级(Ⅰ组,5例),NYHA心功能Ⅱ级(Ⅱ组,23例),NYHA心功能Ⅲ级(Ⅲ组,8例)。分析各组患者各参数与NYHA心功能分级之间的相关性及组间差异。结果Ⅱ组患者右心室舒张末期压力(RVEDP)[(9.61±4.31)mmHg比(7.40±3.36)mmHg,P=0.03]和右心室收缩末期压力(RVESP)[(91.37±29.62)mmHg比(45.38±28.01)mmHg,P=0.006]、Ⅲ组患者RVEDP[(13.75±7.44)mmHg比(7.40±3.36)mmHg,P=0.03]和RVESP[(93.45±30.56)mmHg比(45.38±28.01)mmHg,P=0.006]均显著高于Ⅰ组,差异均有统计学意义。Spearman相关性分析显示,NYHA心功能Ⅰ级、Ⅱ级、Ⅲ级患者间右心室收缩末期容积(RVESV)(R=0.375,P=0.02)、RVEDP(R=0.377,P=0.03)和RVESP(R=0.378,P=0.02)呈正相关,而右心室舒张末期容积(RVEDV)(R=–0358,P=0.02)呈负相关,差异均具有统计学意义。将患者分为NYHA心功能Ⅰ级比Ⅱ级+Ⅲ级进行分析显示,RVESP(R=0.493,P=0.008)和右心室动脉有效弹性(RVEa)(R=0.345,P=0.02)呈正相关;分为Ⅰ级+Ⅱ级比Ⅲ级进行分析时,RVEDV(R=0.383,P=0.02)、RVESV(R=0.398,P=0.02)和RVEDP(R=0.360,P=0.03)呈正相关,差异均有统计学意义。ROC曲线分析发现,当患者分为NYHAⅠ级和Ⅱ+Ⅲ级两组、预测结局为NYHAⅡ/Ⅲ级时,RVEa灵敏度为0.871,特异度为0.800时,ROC曲线下面积为0.836,P=0.02;RVESP灵敏度为0.903,特异度为0.800时,ROC曲线下面积为0.892,P=0.006,。结论右心室压力-容�Objective To analyze the correlation between the pressure volume parameters and cardiac function in terms of New York Heart Association（NYHA） classification in patients with pulmonary arterial hypertension. Methods Among 36 patients with pulmonary hypertension admitted in our center between April 2015 to June 2016, right heart catheterization recording right atrial pressure curve,right ventricular pressure curve,pulmonary arterial pressure and oxygen saturation curve in different parts was performal.All patients recived underwent cardiac MRI examination to obtain a single cardiac cycle and the use of Mass software to measure right ventricular volume continuously and right ventricular pressure-volume loop parameters were then obtained. Patients were divided into different groups according to the NYHA functional classification, and the correlation between the parameters of each group and the cardiac function classes a were analyzed. Results Compare to patients with NYHA class heart function,patients with NYHA heart function class Ⅱ and class Ⅲ had significantly higher right ventricular end diastolic pressure（P〈 0.05）and higher right ventricular systolic pressure（P 〈0.01）. Spearman correlation analysis showed that cardiac function of NYHA classⅠ,Ⅱ and Ⅲ had position correlation with RVESV,RVEDP and RVESP wheras negative correlation with RVEDV. ROC curve analysis showed that,when the patients were divided into 2 groups as NYHA vs. NYHA class Ⅱ ＋ Ⅲ,NYHA classification for predicting the outcome of the NYHA class Ⅱ ＋ Ⅲ level, pulmonary artery elasticity and right ventricular end systolic pressure had larger area under curves respectively. Conclusions Pressure-volume parameters of right ventricles are more objective indicators for cardiac function assessment for pulmonary hypertension patients and evaluation of disease progression especialy in patients with mild symptoms.

关 键 词：肺动脉高压 右心室 NYHA心功能分级 压力-容积关系 

分 类 号：R543.2[医药卫生—心血管疾病]