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首页> 外文期刊>Pulmonary Circulation >Pulmonary Hypertension is a Manifestation of Congestive Heart Failure and Left Ventricular Diastolic Dysfunction in Octogenarians with Severe Aortic Stenosis:
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Pulmonary Hypertension is a Manifestation of Congestive Heart Failure and Left Ventricular Diastolic Dysfunction in Octogenarians with Severe Aortic Stenosis:

机译：肺动脉高压是患有严重主动脉瓣狭窄的八十岁老人的充血性心力衰竭和左心室舒张功能障碍的表现：

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Previous studies have suggested that pulmonary hypertension (PH) in severe aortic stenosis (AS) is a risk factor for operative mortality with aortic valve replacement (AVR). Conversely, others have shown that patients with AS and PH extract a large symptomatic and survival benefit from AVR compared with those patients not treated surgically. We sought to evaluate the prevalence, severity, and mechanism of PH in an elderly patient cohort with severe AS. We prospectively evaluated 41 patients aged ≥80 years with severe AS. All patients underwent cardiac catheterization and transthoracic echocardiography within 24 hours. We found that PH was common in this cohort: 32 patients (78%) had PH; however, the predominant mechanism of PH was left heart congestion. Patients with PH had nearly double the pulmonary artery wedge pressure of patients without PH (23 vs. 13 mmHg; P ≤ 0.001). In patients with PH compared with those without, pulmonary vascular resistance was higher yet still under 3 Wood units (WU; 2.9 vs. 1.5 WU; P = 0.001), and the transpulmonary gradient (11 vs. 7 mmHg; P = 0.01) and diastolic pulmonary gradient (DPG; 3.0 vs. 2.7 mmHg; P = 0.74) were in normal range. Left ventricular diastolic abnormalities were more common in patients with severe AS and PH. Right ventricular (RV) dysfunction was common (13/41 patients, 32%), but the PH and non-PH groups had similar tricuspid annular plane systolic excursion (2.0 vs. 2.3 cm; P = 0.15). Only 2 subjects had both RV dysfunction and an elevated DPG. In conclusion, PH is common in elderly patients with severe AS. This occurs largely due to left heart congestion, with a relative absence of pulmonary vascular disease and RV dysfunction, and as such, PH may serve as a heart failure equivalent in these patients.
机译：先前的研究表明，严重的主动脉瓣狭窄（AS）中的肺动脉高压（PH）是主动脉瓣置换（AVR）导致手术死亡的危险因素。相反，其他研究表明，与未经手术治疗的患者相比，患有AS和PH的患者从AVR提取出大量症状和生存获益。我们试图评估患有严重AS的老年患者队列的PH的患病率，严重程度和机制。我们前瞻性评估了41例年龄≥80岁的严重AS患者。所有患者均在24小时内接受了心脏导管检查和经胸超声心动图检查。我们发现该人群中PH很常见：32例患者（78％）患有PH;然而，PH的主要机制是左心充血。 PH患者的肺动脉楔压几乎是非PH患者的两倍（23 vs. 13 mmHg; P≤0.001）。与没有PH的患者相比，PH患者的肺血管阻力更高，但仍低于3 Wood单位（WU; 2.9 vs. 1.5 WU; P = 0.001）;经肺梯度（11 vs. 7 mmHg; P = 0.01）和舒张期肺梯度（DPG; 3.0 vs. 2.7 mmHg; P = 0.74）在正常范围内。患有严重AS和PH的患者左室舒张期异常更为常见。右心室（RV）功能障碍很常见（13/41例患者，占32％），但PH组和非PH组的三尖瓣环平面收缩期偏移相似（2.0 vs. 2.3 cm; P = 0.15）。只有2名受试者同时患有RV功能障碍和DPG升高。总之，PH在老年AS患者中很常见。发生这种情况的主要原因是左心充血，相对没有肺血管疾病和RV功能障碍，因此，PH在这些患者中可以相当于心力衰竭。

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