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首页> 外文期刊>Pulmonary Circulation >Vasoreactivity to Inhaled Nitric Oxide with Oxygen Predicts Long-Term Survival in Pulmonary Arterial Hypertension:
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Vasoreactivity to Inhaled Nitric Oxide with Oxygen Predicts Long-Term Survival in Pulmonary Arterial Hypertension:

机译：吸入一氧化氮与氧气的血管反应性预测肺动脉高压的长期生存：

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Pulmonary vasodilator testing is currently used to guide management of patients with pulmonary arterial hypertension (PAH). However, the utility of the pulmonary vascular response to inhaled nitric oxide (NO) and oxygen in predicting survival has not been established. Eighty patients with WHO Group I PAH underwent vasodilator testing with inhaled NO (80 ppm with 90% O2 for 10 minutes) at the time of diagnosis. Changes in right atrial (RA) pressure, mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure, Fick cardiac output, and pulmonary vascular resistance (PVR) were tested for associations to long-term survival (median follow-up 2.4 years). Five-year survival was 56%. Baseline PVR (mean±SD 850±580 dyne-sec/cm5) and mPAP (49±14 mmHg) did not predict survival, whereas the change in either PVR or mPAP while breathing NO and O2 was predictive. Patients with a ≥30% reduction in PVR with inhaled NO and O2 had a 53% relative reduction in mortality (Cox hazard ratio 0.47, 95% confidence interval (CI) 0.23–0.99, P=0.047), and those with a ≥12% reduction in mPAP with inhaled NO and O2 had a 55% relative reduction in mortality (hazard ratio 0.45, 95% CI 0.22–0.96, P=0.038). The same vasoreactive thresholds predicted survival in the subset of patients who never were treated with calcium channel antagonists (n=66). Multivariate analysis showed that decreases in PVR and mPAP with inhaled NO and O2 were independent predictors of survival. Reduction in PVR or mPAP during short-term administration of inhaled NO and O2 predicts survival in PAH patients.
机译：肺血管扩张剂测试目前用于指导肺动脉高压（PAH）患者的治疗。但是，尚未确定肺血管对吸入一氧化氮（NO）和氧气的反应在预测生存中的作用。在诊断时，对80例WHO I类PAH患者进行了血管扩张剂测试，吸入NO（80 ppm，90％O2，持续10分钟）。测试了右心房（RA）压力，平均肺动脉压力（mPAP），肺毛细血管楔压，Fick心输出量和肺血管阻力（PVR）的变化与长期生存的相关性（中位随访时间2.4年） 。五年生存率为56％。基线PVR（平均±SD 850±580达因-秒/ cm5）和mPAP（49±14 mmHg）不能预测生存，而呼吸NO和O2时PVR或mPAP的变化是可以预测的。吸入NO和O2使PVR降低≥30％的患者的相对死亡率降低53％（Cox风险比0.47，95％置信区间（CI）0.23–0.99，P = 0.047），以及≥12的患者吸入NO和O2降低mPAP百分率可使死亡率相对降低55％（危险比0.45，95％CI 0.22-0.96，P = 0.038）。相同的血管反应性阈值可预测从未接受过钙通道拮抗剂治疗的患者亚组的存活率（n = 66）。多因素分析表明，吸入NO和O2导致PVR和mPAP降低是生存的独立预测因子。短期吸入NO和O2期间PVR或mPAP的降低可预测PAH患者的生存率。

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