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

Abstract

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.

Keywords

• PULMONARY HYPERTENSION
• cardiac power output
• pulmonary circulation,
• right heart catheterization

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

Abstract

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.

Keywords

• pulmonary arterial hypertension; cardiac power output; pulmonary circulation; right heart catheterization; right ventricle hemodynamics

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