目的 研究左心疾病相关性肺高压(PH-LHD)的发生率和左心疾病病因构成,分析PH-LHD患者的临床特征.方法 入选2013年10月至2015年10月就诊我院心内科经临床和超声心动图检查确诊为左心衰竭的住院患者.左心衰竭的病因包括肥厚型心肌病(HCM)、高血压性心脏病(HHD)、扩张型心肌病(DCM)、缺血性心脏病(IHD)及心脏瓣膜病(VHD).利用连续多普勒超声心动图测定最大三尖瓣返流速度(TRV max),依据伯努利方程计算肺动脉收缩压(PASP)=4×TRVmax2+RAP(右房压).采集PH-LHD患者的临床病史、心力衰竭规范用药情况、合并疾病、超声心动图参数及生化指标.结果 ①PH-LHD的发生率为26.72%.②PH-LHD患者左心衰竭的病因构成依次为IHD 36.87%、VHD 29.95%、DCM 19.82%、HHD 6.91%、HCM 6.45%.③入选的左心衰竭患者中除去VHD患者,429例HFrEF患者中PH的发生率为29.37%;196例HFpEF中肺高压的发生率为13.27%.HFpEF伴PH组中左心疾病病因构成为HCM 42.31%、HHD 34.62%、IHD 23.07%;HFrEF伴PH组中左心疾病病因构成为IHD 58.73%、DCM 34.13%、HHD 4.76%、HCM 2.38%;两组间病因构成明显不同(P=0.000).④DCM伴PH(A组)与IHD伴PH(B组)两组间临床特征比较:与B组相比,A组男性患者比例高(81.4%比64.9%,P<0.044);B组多为高龄,收缩压高,多合并高血压、糖尿病、慢性肾功不全等疾病,差异均有统计学意义(P均<0.05).与B组相比,A组左房内径和左室内径增大更为明显,中-重度二尖瓣返流比例更高,LVEF更低,差异均有统计学意义(P均<0.05).结论 ①IHD和VHD是PH-LHD患者的常见左心疾病病因.②HCM和HHD是HFpEF-PH患者的主要病因;IHD和DCM是HFrEF-PH患者的主要病因.③DCM伴PH组较IHD伴PH组男性患者居多,左心系统增大和左室收缩功能减低更明显.
Objective To investigate the incidence and etiology composition of pulmonary hypertension due to left heart disease(PH-LHD),and analysis the clinical characteristics of PH-LHD patients.Methods Left heart failure patients were enrolled in this study,the etiology of left heart failure including:ischemic heart disease (IHD),dilated cardiomyopathy (DCM),hypertensive heart disease (HHD),hypertrophic cardiomyopathy (HCM) and valvular heart disease (VHD).The maximum velocity of tricuspid regurgitation (TRVmax) were measured by Doppler echocardiography,and PASP(pulmonary artery systolic pressure)was calculated[=4×TRVmax2+right artial pressure(RAP)].The history,clinical vital signs,treatment,complications and echocardiographic parameters were collected.Results (1)The incidence of pulmonary hypertension in the all enrolled left heart disease was 26.72%.(2)In PH-LHD patients,the etiology composition of left heart disease as follows:IHD 36.87%,VHD 29.95%,DCM 19.82%,HHD 6.91% and HCM 6.45%.(3)Removing the VHD patients from left heart failure patients,429 of them were HFrEF,and The incidence of PH in patients with HFrEF was 29.37%;the incidence of PH in patients with HFpEF was 13.27%.The etiology composition of PH-LHD in patients with HFpEF:HCM 42.31%,HHD 34.62% and IHD 23.07%.The etiology composition of PH-LHD in patients with HFrEF:IHD 58.73%,DCM 34.13%,HHD 4.76% and HCM 2.38%.The etiology composition between two groups has significant difference (P=-0.000).(4)In PH-LHD patients,selected DCM and IHD patients (LVEF<50%,DCM with PH was defined as group A,IHD with PH was defined as group B).Comparing with the group B,the patients in group A demonstrated a higher proportion of male and moderate-severe mitral regurgitation,the size of left atrial and left ventricular were increased,and lower left ventricular ejection fraction (P<0.05).Comparing with the group A,Patients in group B were older,higher SBP,and higher prevalence of diabetes,chronic renal failure and hypertension (P<0.05).Conclusion (1)IHD and VHD are the two major causes of PH-LHD patients.(2)The two major cause of PH-LHD in patients with HFpEF are HCM and HHD,while in patients with HFrEF are IHD and DCM.(3)Comparison the clinical characteristics between DCM and IHD patients with PH,the former has mostly male patients,left heart size increased significantly,LVEF significandy reduced.