Funktionelle Charakterisierung von Patienten mit isoliert postkapillärer oder kombiniert post- und präkapillärer pulmonaler Hypertonie

 

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Zusammenfassung

Hintergrund Nach Empfehlungen der letzten PH-Weltkonferenz wird die Differenzierung von isoliert postkapillärer (Ipc) und kombiniert post- und präkapillärer (Cpc) PH allein nach pulmonal-vaskulärem Widerstand (PVR) empfohlen. Ziel dieser Arbeit war es, Patienten mit IpcPH und CpcPH nach den aktualisierten Empfehlungen basierend auf der letzten Weltkonferenz für pulmonale Hypertonie (PH) hämodynamisch und im Rahmen einer explorativen Datenanalyse funktionell zu charakterisieren.

Methoden Evaluiert wurden Patienten, die sich von 2008 bis 2015 in der PH-Ambulanz der Missioklinik Würzburg mit Verdacht auf PH zur leitlinienkonformen Diagnostik vorstellten. Analysiert wurden alle Patienten mit einem pulmonal-arteriellen Mitteldruck (mPAP) von ≥ 25 mmHg und einem pulmonalkapillären Verschlussdruck (PCWP) > 15 mmHg. Es erfolgte der Vergleich anthropometrischer, hämodynamischer und funktioneller Daten aus 6-Minuten-Gehtest (6MWT), Spiroergometrie und Echokardiografie bei IpcPH und CpcPH.

Ergebnisse Von 726 Patienten zeigten 58 eine postkapilläre PH: IpcPH: n = 20; CpcPH: n = 38. Patienten mit IpcPH besaßen einen signifikant niedrigeren mPAP und PVR als Patienten mit CpcPH. Der Herzindex war in der CpcPH-Gruppe niedriger als in der IpcPH-Gruppe. Die funktionelle Kapazität beider Gruppen war nicht verschieden. Patienten mit CpcPH hatten einen größeren rechts-linksatrialen Flächen(RA/LA)-Quotienten.

Diskussion und Schlussfolgerung Trotz höherem mPAP und PVR von Patienten mit CpcPH findet sich keine schlechtere funktionelle Kapazität als bei IpcPH. Bei Patienten mit Linksherzerkrankungen und PH kann ein erhöhter RA/LA-Index ein möglicher Hinweis für eine CpcPH sein und Anlass zur invasiven Diagnostik geben.

Abstract

Background The World Conference on PH recommended differentiation of isolated postcapillary (Ipc) and combined post- and precapillary (Cpc) PH according to pulmonary vascular resistance alone. The aim of this study was the haemodynamic and functional characterization of patients diagnosed IpcPH and CpcPH according to the current recommendation of the latest World Symposium on Pulmonary Hypertension (PH) with an exploratory data analysis.

Methods We evaluated all consecutive patients presenting at the PH outpatient clinic of Mission Medical Hospital from 2008–2015. All received a complete diagnostic work-up according to the guidelines. We analyzed data of patients with mPAP≥ 25 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. We compared anthropometric, hemodynamic and functional data of six-minute walking test (6 MWT), cardiopulmonary exercise testing (CPET) and echocardiography of patients with IpcPH and CpcPH.

Results Out of 726 patients 58 showed a postcapillary PH: IpcPH: n = 20; CpcPH: n = 38. Patients with IpcPH had a significantly lower mPAP and PVR than patients with CpcPH. Cardiac index was lower in the Cpc-PH group compared to the IpcPH group. Functional capacity did not differ. CpcPH patients showed a higher right/left atrial area (RA/LA)-ratio.

Discussion and conclusion Although CpcPH patients showed higher values of mPAP and PVR functional capacity was not worse than in patients with IpcPH. In patients with PH due to left heart disease an elevated RA/LA ratio may indicate CpcPH and invasive diagnostic work-up should be considered.

Publication History

Article published online:
20 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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