Araştırma Makalesi
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Pulmoner Arteryel Hipertansiyonda Sağ Ventrikül Kardiyak Atım Gücünün Mortalite Belirteci Olarak Değerlendirilmesi

Yıl 2021, , 794 - 802, 27.12.2021
https://doi.org/10.31832/smj.915463

Öz

Amaç: Sağ kalp kateterizasyonu pulmoner arteryel hipertansiyonun (PAH) tanısında altın standart olmanın yanı sıra, hastalığın ciddiyetinin belirlenmesi ve takip eden süreçte tedaviye yanıtın değerlendirilmesi açısından önemli bir rol oynamaktadır. Kardiyak atım gücü (KAG) ise akım ve basıncın bir bileşkesi olup kalbin pompa fonksiyonuna ilişkin bilgi vermektedir. Çalışmanın amacı KAG değerinin PAH hastalarında prognostik faktör olarak kullanımının araştırılmasıdır.
Materyal ve metodlar: Çalışmada; Eylül 2009- Haziran 2019 yılları arasında, 105 tedavi naif, yeni tanı Grup 1 PAH hastası araştırılmıştır. Araştırılan KAG değeri Watt cinsinden kardiyak atım hacmi ve ortalama pulmoner arter basıncının çarpımının 451 sabitine bölünmesi ile bulunmuştur.
Bulgular: KAG değeri yüksek riskli hastalarda (0.25 ± 0.02 W Yüksek risk, 0.42 ± 0.15 W düşük risk, ve 0.44 ± 0.10 W orta-risk; p=0.04) düşük ve orta-riskli hastalara kıyasla anlamlı ölçüde düşük bulunmuştur. Orta ve düşük riskli grupta, lojistik regresyon analizi neticesinde sağ ventriküle ait KAG değeri artış gösterdikçe mortalitenin arttığı gösterilmiştir (HR: 2,06, 95% CI: 1.1-3.03, p=0.03). Kırılma noktasının ROC analizi ile 0.44 W olduğu,bu değerin üstündeki düşük-orta risk profilinde mortalitenin yüksek seyrettiği görülmüştür.
Sonuç: KAG; kardiyak rezervi göstermesi açısından PAH hastalarında gelecek vaad eden bir parametre olarak göze çarpmaktadır. Yüksek riskli grupta rezervin tükendiğine işaret eder nitelikte düşük seyrederken, rezervini tam anlamıyla yitirmemiş orta-düşük riskli grupta kompansatuar rezervin üst sınırına gelecek şekilde artış gösterdiği bu sınır aşıldıktan sonra mortalite artışının işareti olan bir parametre olarak değerlendirilebilir.

Kaynakça

  • 1. Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation 2009; 119: 147–152.
  • 2. Nossaman BD, Scruggs BA, Nossaman VE, et al. History of right heart catheterization: 100 years of experimentation and methodology development. Cardiol Rev 2010; 18: 94–101.
  • 3. Stephan Rosenkranz, Ioana R. Preston. Right heart catheterization: best practice and pitfalls in pulmonary hypertension. European Respiratory Review Dec 2015, 24 (138) 642- 652; DOI: 10.1183/16000617.0062-2015
  • 4. Cotter G., Williams SG, Vered Z., et al. Role of cardiac power in heart failure. Curr Opin Cardiol. 2003;18:215-22.
  • 5. Rupert Fincke, Judith S. Hochman, April M. Lowe, et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry. J Am Coll Cardiol. 2004; 44:340-8.
  • 6. Williams SG, Cooke GA, Wright DJ, et al. Peak exercise cardiac power output; a direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure. Eur Heart J.2001;22:1496-503.
  • 7. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67- 119. doi:10.1093/eurheartj/ehv317
  • 8. Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120(11):992-1007. doi:10.1161/CIRCULATIONAHA.106.674028
  • 9. Lupi HE, Chuquiure VE, González PH, et al. “Cardiac Power Output” an old tool, possibly a modern tool for assessing cardiac pumping capability, as well as for a short-term prognosis in cardiogenic shock due to acute myocardial infarction. Arch Cardiol Mex. 2006;76(1):95-108.
  • 10. Yildiz, O., Aslan, G., Demirozu, Z. T., Yenigun, C. D., & Yazicioglu, N. (2017). Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure. The American Journal of Cardiology, 120(6), 973–979.doi:10.1016/j.amjcard.2017.06.028
  • 11. Hoeper, MM Kramer, T, Pan, Z, et al. Mortality in pulmonary arterial hypertension prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J 2017; 50: 1700740.
  • 12. Yogeswaran A, Richter MJ, Sommer N, et al. Advanced risk stratification of intermediate risk group in pulmonary arterial hypertension. Pulmonary Circulation. October 2020. doi:10.1177/2045894020961739
  • 13. Yu Xie, William Auger, Michael Madani, et al. Right ventricular cardiac power output is inversely related to pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2012 Mar, 59 (13 Supplement) E1610.
  • 14. Nazzareno Galié, Alessandra Manes, Massimiliano Palazzini, et al. Pharmacological impact on right ventricular remodelling in pulmonary arterial hypertension, European Heart Journal Supplements, Volume 9, Issue suppl_H, 1 December 2007, Pages H68– H74, https://doi.org/10.1093/eurheartj/sum055
  • 15. A. Vonk Noordegraaf, N. Galiè. The role of the right ventricle in pulmonary arterial hypertension. European Respiratory Review Dec 2011, 20 (122) 243-253; DOI: 10.1183/09059180.00006511
  • 16. Lupi-Herrera E, Sandoval J, Figueroa J, et al. Left and right ventricular power: outputs are the strongest hemodynamic correlates to allow identification of acute responders to vasodilator treatment in idiopathic pulmonary arterial hypertension. Arch Cardiol Mex. 2011 Apr- Jun;81(2):100-7. PMID: 21775243.
  • 17. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what's old is new. F1000Res. 2019 Jun 19;8:F1000 Faculty Rev-888. doi: 10.12688/f1000research.18811.1. PMID: 31249672; PMCID: PMC6584967.
  • 18. Hoeper MM, Kramer T, Pan Z, et al. Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J 2017; 50: 1700740.
  • 19. Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J 2017; 50: 1700889.
  • 20. Gall, H, Felix, JF, Schneck, FK, et al. The Giessen Pulmonary Hypertension Registry: survival in pulmonary hypertension subgroups. J Heart Lung Transplant 2017; 36: 957–967.
  • 21. Benza RL, Gomberg-Maitland M, Miller DP, et al. The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest 2012;141:354-62.
  • 22. Benza RL, Elliott CG, Farber HW, et al. Updated Risk Score Calculator for Patients with Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). Am J Respir Crit Care Med 2017;195:A6899-A.

Right Ventricular Cardiac Power Output as a Mortality Predictor in Patients with Pulmonary Arterial Hypertension

Yıl 2021, , 794 - 802, 27.12.2021
https://doi.org/10.31832/smj.915463

Öz

Objectives:Right heart catheterization (RHC) is a gold standard method for diagnosis, also monitors the level of the disease, the prognosis, and the response to the therapy in patients with pulmonary arterial hypertension (PAH). Cardiac power output (CPO) is the product of flow and pressure. Aim of this study was to evaluate right ventricular cardiac power output (RVCPO) in PAH patients as a prognostic factor.

Materials and methods: Demographic characteristics, functional class, RHC findings, echocardiographic data, PAH-specific medical treatment usage of 105 treatment-naïve, newly diagnosed Group 1 PAH patients between September 2009 and June 2019 were reviewed. RVCPO (Watt) was calculated as a product of cardiac output (CO) and mean pulmonary artery pressure (mPAP), divided by a constant of 451.

Results: RVCPO was lower in high-risk patients (0,25 ± 0,02 W for high risk, 0,42 ± 0,15 W for low risk, and 0,44 ± 0,10 W for intermediate-risk; p=0.04) in comparison with low and intermediate-risk patients. RVCPO showed very high correlation with mPAP while a low positive correlation with CO, and PVR. 0,44 W for RVCPO was found the most accurate predictor value for mortality in low and intermediate-risk patients by ROC analysis.

Conclusion: RVCPO could be a promising hemodynamic parameter that represents cardiac pumping ability with PAH patients. RVCPO tends to increase with low and intermediate risk while decrease with high-risk and associated with mortality above 0,44 W with low and intermediate-risk patients. We suggest that RVCPO could be a beneficial hemodynamic tool to discriminate the patients at-risk among the low and intermediate-risk groups.

Kaynakça

  • 1. Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation 2009; 119: 147–152.
  • 2. Nossaman BD, Scruggs BA, Nossaman VE, et al. History of right heart catheterization: 100 years of experimentation and methodology development. Cardiol Rev 2010; 18: 94–101.
  • 3. Stephan Rosenkranz, Ioana R. Preston. Right heart catheterization: best practice and pitfalls in pulmonary hypertension. European Respiratory Review Dec 2015, 24 (138) 642- 652; DOI: 10.1183/16000617.0062-2015
  • 4. Cotter G., Williams SG, Vered Z., et al. Role of cardiac power in heart failure. Curr Opin Cardiol. 2003;18:215-22.
  • 5. Rupert Fincke, Judith S. Hochman, April M. Lowe, et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry. J Am Coll Cardiol. 2004; 44:340-8.
  • 6. Williams SG, Cooke GA, Wright DJ, et al. Peak exercise cardiac power output; a direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure. Eur Heart J.2001;22:1496-503.
  • 7. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67- 119. doi:10.1093/eurheartj/ehv317
  • 8. Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120(11):992-1007. doi:10.1161/CIRCULATIONAHA.106.674028
  • 9. Lupi HE, Chuquiure VE, González PH, et al. “Cardiac Power Output” an old tool, possibly a modern tool for assessing cardiac pumping capability, as well as for a short-term prognosis in cardiogenic shock due to acute myocardial infarction. Arch Cardiol Mex. 2006;76(1):95-108.
  • 10. Yildiz, O., Aslan, G., Demirozu, Z. T., Yenigun, C. D., & Yazicioglu, N. (2017). Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure. The American Journal of Cardiology, 120(6), 973–979.doi:10.1016/j.amjcard.2017.06.028
  • 11. Hoeper, MM Kramer, T, Pan, Z, et al. Mortality in pulmonary arterial hypertension prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J 2017; 50: 1700740.
  • 12. Yogeswaran A, Richter MJ, Sommer N, et al. Advanced risk stratification of intermediate risk group in pulmonary arterial hypertension. Pulmonary Circulation. October 2020. doi:10.1177/2045894020961739
  • 13. Yu Xie, William Auger, Michael Madani, et al. Right ventricular cardiac power output is inversely related to pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2012 Mar, 59 (13 Supplement) E1610.
  • 14. Nazzareno Galié, Alessandra Manes, Massimiliano Palazzini, et al. Pharmacological impact on right ventricular remodelling in pulmonary arterial hypertension, European Heart Journal Supplements, Volume 9, Issue suppl_H, 1 December 2007, Pages H68– H74, https://doi.org/10.1093/eurheartj/sum055
  • 15. A. Vonk Noordegraaf, N. Galiè. The role of the right ventricle in pulmonary arterial hypertension. European Respiratory Review Dec 2011, 20 (122) 243-253; DOI: 10.1183/09059180.00006511
  • 16. Lupi-Herrera E, Sandoval J, Figueroa J, et al. Left and right ventricular power: outputs are the strongest hemodynamic correlates to allow identification of acute responders to vasodilator treatment in idiopathic pulmonary arterial hypertension. Arch Cardiol Mex. 2011 Apr- Jun;81(2):100-7. PMID: 21775243.
  • 17. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what's old is new. F1000Res. 2019 Jun 19;8:F1000 Faculty Rev-888. doi: 10.12688/f1000research.18811.1. PMID: 31249672; PMCID: PMC6584967.
  • 18. Hoeper MM, Kramer T, Pan Z, et al. Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J 2017; 50: 1700740.
  • 19. Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J 2017; 50: 1700889.
  • 20. Gall, H, Felix, JF, Schneck, FK, et al. The Giessen Pulmonary Hypertension Registry: survival in pulmonary hypertension subgroups. J Heart Lung Transplant 2017; 36: 957–967.
  • 21. Benza RL, Gomberg-Maitland M, Miller DP, et al. The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest 2012;141:354-62.
  • 22. Benza RL, Elliott CG, Farber HW, et al. Updated Risk Score Calculator for Patients with Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). Am J Respir Crit Care Med 2017;195:A6899-A.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Sena Sert 0000-0002-3735-1053

Lale dinç Asarcıklı 0000-0002-7828-9487

Aycan Esen Bu kişi benim 0000-0003-4235-351X

Altuğ Ösken 0000-0003-3018-339X

Barış Şimşek Bu kişi benim 0000-0001-9412-0035

Aysel Yağmur 0000-0002-1773-1956

Barış Güngör

Özlem Yıldırımtürk 0000-0001-9841-4524

Yayımlanma Tarihi 27 Aralık 2021
Gönderilme Tarihi 14 Nisan 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

AMA Sert S, Asarcıklı L, Esen A, Ösken A, Şimşek B, Yağmur A, Güngör B, Yıldırımtürk Ö. Right Ventricular Cardiac Power Output as a Mortality Predictor in Patients with Pulmonary Arterial Hypertension. Sakarya Tıp Dergisi. Aralık 2021;11(4):794-802. doi:10.31832/smj.915463

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