应用心导管检查技术评估梗阻性肥厚型心肌病肺动脉压力相关影响因素  

Construction of Linear Regression Models to Examine the Association between Pulmonary Hypertension and Left Ventricular Outflow Tract Obstruction in Patients with Obstructive Hypertrophic Cardiomyopathy by Cardiac Catheterization

作　　者：刘文超 陆政阳 胡海波 吕建华 刘垚 朱昌盛 聂长荣 卢涛 蒙延海 杨秋蓝 LIU Wenchao;LU Zhengyang;HU Haibo;LYU Jianhua;LIU Yao;ZHU Changsheng;NIE Changrong;LU Tao;MENG Yanhai;YANG Qiulan(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Center of Structure Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院成人外科中心,北京100037 [2]中国医学科学院阜外医院结构性心脏病中心,北京100037

出　　处：《中国分子心脏病学杂志》2024年第6期6444-6452,共9页Molecular Cardiology of China

基　　金：中国医学科学院医学与健康科技创新工程项目(2023-I2M-1-001,2024-I2M-C&T-B-046);四大慢病重大专项(2023ZD0504500)

摘　　要：目的探讨梗阻性肥厚型心肌病(OHCM)患者合并肺动脉高压(PH)的相关影响因素,并确认肺动脉压力与左心室流出道(LVOT)压差之间的关系。方法2021年1—8月连续纳入OHCM患者,同期行右心导管检查及左心导管检查,研究平均肺动脉压(MPAP)与左心导管检查指标的线性回归关系。结果32例患者完成双心导管检查。根据PH诊断标准,14例(43.8%)患者纳入PH组,18例(56.2%)患者纳入非PH组。PH组MPAP为(35.4±14.5)mmHg(1 mmHg=0.133 kPa),非PH组MPAP为(17.1±4.4)mmHg,两组间比较差异有统计学意义(P<0.001),两组间肺动脉收缩压和舒张压差异也均有统计学意义(P均<0.001)。PH组PVR为(7.1±3.4)wood,非PH组PVR为(3.5±1.5)wood,两组间比较差异有统计学意义(P<0.001)。PH组左心房平均压(MLAP)为(24.5±7.8)mmHg,非PH组MLAP为(15.9±4.4)mmHg,组间比较差异有统计学意义(P<0.001)。两组间左心室舒张末压(LVEDP)差异有统计学意义(P=0.012)。设定年龄、体重指数、左心房内径(LAD)、MLAP、LVOT压差为自变量,设定MPAP为因变量,二元线性回归分析结果表明,LAD(P=0.012,R^(2)=0.610)、MLAP(P<0.001,R^(2)=0.165)、LOVT压差(P<0.001,R^(2)=0.323)与MPAP呈线性相关性。多元线性逐步回归分析结果表明,LAD(P=0.006)、MLAP(P<0.001)、LOVT压差(P=0.001)与MPAP可共同解释MPAP变化的77.6%,拟合方程为:MPAP=0.63×LAP+0.310×LOVT压差+0.259×MLAP-26.345(R=0.798,R^(2)=0.776)。OHCM患者的PH与左心房压升高和增大相关,而MPAP与LOVT梯度呈线性相关。结论OHCM患者的PH与左心房压力增高相关,并且与LOVT梗阻压力升高具有线性相关性。术前PH与室间隔心肌切除术后的不良临床结局相关。Objective The factors of pulmonary hypertension(PH)in patients with obstructive hypertrophic cardiomyopathy(OHCM)are not well studied.There′s few research concerning association between pulmonary hypertension and left ventricular outflow tract obstruction or diastolic disfunction and in patients with OHCM.To explore the related factors of PH and determine the relationship between pulmonary artery pressure and LVOT gradient by use of cardiac catheterization.Methods From January,2021 to August,2021,32 OHCM patients were consecutively enrolled.A transcatheter hemodynamic study was performed before surgery,including right heart catheterization and left heart catheterization.Linear regression model was built between mean pulmonary artery pressure(MPAP)and left heart catheterization parameters.Results Cardiac catheterization was done on 32 patients.According to the PH diagnostic criteria,14 patients(43.8%)were diagnosed as PH group,and 18 patients(56.2%)were non⁃PH group.The MPAP of the PH group was 35.4±14.5 mmHg,and 17.1±4.4 mmHg in the non⁃PH group,the difference was statistically significant between 2 groups(P<0.001).The PVR of the PH group was 7.1±3.4 Wood,and 3.5±1.5 Wood in non⁃PH group,the difference was statistically significant between 2 groups(P<0.001).Mean left atrial pressure(MLAP)in the PH group was 24.5±7.8 mmHg,and 15.9±4.4 mmHg in the non⁃PH group was.The difference was statistically significant between 2 groups(P<0.001).Left ventricular end diastolic pressure(LVEDP)was statistically different between the PH group and the non⁃PH group(P=0.012).Age,body mass index,left atrium diameter(LAD),MLAP and LVOT gradient were concluded as independent variables,MPAP was set as dependent variable,with binary linear regression analysis the results showed that:LAD(P=0.012,R^(2)=0.610),MLAP(P<0.001,R^(2)=0.165),LOVT gradient(P<0.001,R^(2)=0.323)were linearly correlated with MPAP.With multifactor linear stepwise regression analysis,the results showed that:LAD(P=0.006),MLAP(P<0.001),LOVT pressure diff

关 键 词：梗阻性肥厚型心肌病 肺动脉高压 左心室流出道梗阻 心导管检查 

分 类 号：R542.2[医药卫生—心血管疾病]