The Differential Impact of the Left Atrial Pressure Components on Pulmonary Arterial Compliance-Resistance Relationship in Heart Failure

JOURNAL OF CARDIAC FAILURE

卷:27

Article

Najjar, Emil^1,2  Lund, Lars H.^1,2  Hage, Camilla^1,2  Nagy, Aniko, I^1,3  Johnson, Jonas^1,2,4  Manouras, Aristomenis^1,2 

[1] Karolinska Inst, Dept Med, Stockholm, Sweden

[2] Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden

[3] Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary

[4] Karolinska Univ Hosp, Ctr Foetal Med, Dept Obstet & Gynaecol, Stockholm, Sweden

关键词: heart failure;    pulmonary arterial compliance;    pulmonary vascular resistance;    pulmonary artery wedge pressure;   

DOI  :  10.1016/j.cardfail.2020.09.008

来源: Elsevier

【 摘 要 】

Background: An increase in the pulmonary capillary wedge pressure (PAWP) has been shown to impact on the inherent relationship between the pulmonary arterial compliance (PAC) and pulmonary vascular resistance (PVR), thus augmenting the pulsatile relative to the resistive load of the right ventricle. However, the PAWP comprises the integration of both the steady and the pulsatile pressure components. We sought to address the differential impact of the these distinct PAWP components on the PAC-PVR relationship in a cohort of patients with heart failure. Methods and Results: The study population consisted of 192 patients with hemodynamic findings diagnostic for heart failure. Off-line analysis was performed using the MATLAB software. The steady and pulsatile PAWP components were calculated as mid-A pressure and mean pressure during the V-wave oscillation, respectively. The PAC and PVR were hyperbolically and inversely associated and the subgroup of patients with PAWP above the median ( > 18 mm Hg) displayed a significant left and downward shift of the curve fit (P < .001). The shift in the PAC-PVR fit between patients with higher versus low steady PAWP was not significant (P = .43). In contrast, there was a significant downward and leftward shift of the PVR-PAC curve fit for the subgroup with a higher pulsatile PAWP (P < .001). Furthermore, only the pulsatile PAWP was significantly associated with the time-constant of the pulmonary circulation, assessed as the PAC x PVR product (P < .001). Conclusions: In patients with heart failure, the pulsatile rather than the steady PAWP component stands for the previously documented shift of the PAC-PVR relationship occurring at an elevated PAWP.

【 授权许可】

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