[1]段宇 贾静 步睿 李涛 韦宏.急性伊洛前列素吸入对肺动脉高压患者右心室功能的影响[J].心血管病学进展,2019,(9):1319-1322.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.034]
　DUAN Yu,JIA Jing,BU Rui,et al.The Effect of Acute Iloprost Inhalation on Right Ventricular Function in Pulmonary Arterial Hypertension[J].Advances in Cardiovascular Diseases,2019,(9):1319-1322.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.034]
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急性伊洛前列素吸入对肺动脉高压患者右心室功能的影响()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2019年9期
页码:
1319-1322
栏目:
论著
出版日期:
2019-12-25

文章信息/Info

Title:
The Effect of Acute Iloprost Inhalation on Right Ventricular Function in Pulmonary Arterial Hypertension
作者:
段宇 贾静 步睿 李涛 韦宏
(哈尔滨医科大学附属第四医院,黑龙江 哈尔滨 150001)
Author(s):
DUAN Yu;  JIA Jing;  BU Rui;  LI Tao;  WEI Hong
(The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001,Heilongjiang,China)
关键词:
伊洛前列素; 右心室功能; 肺动脉高压; 心脏磁共振成像
Keywords:
Iloprost; Right ventricle function; Pulmonary arterial hypertension; Cardiovascular magnetic resonance imaging
DOI:
10.16806/j.cnki.issn.1004-3934.2019.09.034
摘要:
目的 右心室功能是影响肺动脉高压患者预后的重要因素。本研究通过心脏磁共振成像及右心导管检查，评估急性伊洛前列素吸入对肺动脉高压患者右心室功能的即刻影响。方法 选择2015年9月—2017年12月肺动脉高压患者43例，其中特发性肺动脉高压患者23例，结缔组织病相关性肺高压患者20例。患者均在基线状态及吸入伊洛前列素5 μg，20 min后行右心导管及心脏磁共振成像检查。结果 急性伊洛前列素吸入使肺血管阻力从（12±7）Wood降低到（9±5）Wood单位，右室射血分数从（30±11）%增加到（35±12）%（P<0.05），右室搏出量从（53±21）mL增加到（57±22）mL（P<0.05），舒张末期右室容积从（179±67）mL减少到（172±69）mL（P<0.05）。在特发性肺动脉高压患者中，急性伊洛前列素吸入诱导的右室射血分数改善程度与肺血管阻力降低程度相关（P<0.000 1）。结论 急性伊洛前列素吸入改善了特发性肺动脉高压和结缔组织病相关性肺高压患者的右室射血分数、右室搏出量，减少了舒张末期右室容积。在特发性肺动脉高压患者中，右室射血分数增加与肺血管阻力的减少成正比。
Abstract:
Objective Right ventricle function is among the most important prognostic factors for pulmonary arterial hypertension (PAH) patients.The aim of this study is to investigate acute ight ventricle response to inhalation of aerosolized iloprost in patients with PAH using CMRI. Methods This study involved 43 incident PAH patients, including 23 idiopathic PAH (IPAH) patients, 20 patients with PAH associated with connective tissue disease (CTD-PAH) .All patients underwent both right heart catheterization and cardiac magnetic resonance imaging at baseline and 20 min after 5 ?g iloprost inhalation. Results Acute iloprost inhalation reduced pulmonary vascular resistance (PVR) from (12±7) Wood U to (9±5) Wood U (P<0.05), increased right ventricle ejection fraction (RVEF) from (30±11)% to (35±12) % (P<0.05), increased right ventricle stroke volume from (53±21)mL to (57±22) mL (P<0.05) and decreased right ventricle end-diastolic volume from(179±67)mL to(172±69)mL (P<0.05). Acute iloprost inhalation-induced RVEF improvement was correlated withthe degree of PVR reduction (P<0.000 1) in IPAH patients,but not in CTD-PAH patients.Conclusion Acute iloprost inhalation improved RVEF,right ventricle stroke volume and decreased right ventricle volume in IPAH and CTD-PAH patients. Iloprost-induced RVEF increase was proportional to PVR reduction in IPAH patients, but not in CTD-PAH patients

参考文献/References:

[1].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)[J]. Eur Heart J,2016,37(1):67-119.?
[2].Olschewski H, Simonneau G, Galiè N,et al. Inhaled iloprost for severe pulmonary hypertension[J].N Engl J Med,2002,347(5):322-329.
[3].Martischnig AM, Tichy A, Nikfardjam M, et al. Inhaled iloprost for patients with precapillary pulmonary hypertension and right-side heart failure[J]. J Card Fail,2011,17(10):813-818.
[4].Jing ZC,?Jiang X,?Han ZY, et al. Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension[J].Eur Respir J,2009,33(6):1354-1360.
[5].Rich S, McLaughlin VV. The effects of chronic prostacyclin therapy on cardiac output and symptoms in primary pulmonary hypertension[J]. J Am Coll Cardiol,1999,34(4):1184-1187.
[6].Gomez-Arroyo J, Sakagami M, Syed AA, et al.Iloprost reverses established fibrosis in experimental right ventricular failure[J]. Eur Respir J,2015,45(2):449-462.
[7].Rex S, Missant C, Claus P,et al. Effects of inhaled iloprost on right ventricular contractility, right ventriculo-vascular coupling and ventricular interdependence: a randomized placebo-controlled trial in an experimental model of acute pulmonary hypertension[J].Crit Care,2008,12(5):R113.
[8].Baggen VJ,?Leiner T,?Post MC,et al. Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis[J]. Eur Radiol,2016,26(11):3771-3780.
[9].Brewi MJ, Bellofiore A, Vanderpool RR, et al.Imaging right ventricular function to predict outcome in pulmonary arterial hypertension[J].Int J Cardiol,2016,218:206-211.
[10].Vonk Noordegraaf A, Westerhof BE, Westerhof N.The relationship between the right ventricle and its load in pulmonary hypertension[J]. J Am Coll Cardiol,2017,69(2):236-243.?
[11].Wauthy P,?Abdel Kafi S,?Mooi WJ, et al. Inhaled nitric oxide versus prostacyclin in chronic shunt-induced pulmonary hypertension[J].J Thorac Cardiovasc Surg,?2003,126(5):1434-1441.
[12].Holmboe S, Andersen A, Jensen RV, et al. Prostacyclins have no direct inotropic effect on isolated atrial strips from the normal and pressure-overloaded human right heart[J].Pulm Circ,2017,7(2):339-347.
[13].Kemming G, Kisch-Wedel H, Flondor M,et al.Improved ventricular function during inhalation of PGI(2) aerosol partly relies on enhanced myocardial contractility[J].Eur Surg Res,2005,37(1):9-17.
[14].Holmboe S, Andersen A, Vildbrad MD,et al. Iloprost improves ventricular function in the hypertrophic and functionally impaired right heart by direct stimulation[J].Pulm Circ,2013,3(4):870-879.?
[15].Freed BH,?Gomberg-Maitland M,?Chandra S, et al. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension[J].J Cardiovasc Magn Reson,?2012,14:11.?
[16].Shehata ML,?Lossnitzer D,?Skrok J,et al.Myocardial delayed enhancement in pulmonary hypertension: pulmonary hemodynamics, right ventricular function, and remodeling[J].AJR Am J Roentgenol,?2011,196(1):87-94.?
[17].van de Veerdonk MC,?Huis In T Veld AE,?Marcus JT, et al. Upfront combination therapy reduces right ventricular volumes in pulmonary arterial hypertension[J].Eur?Respir?J,?2017,49(6).?pii: 1700007. doi: 10.1183/13993003.00007-2017.

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备注/Memo

备注/Memo:

更新日期/Last Update: 2020-02-06