domingo, novembro 13, 2011
Rio abaixo, rio acima na hipertensão pulmonar
Contribution of Ventricular Diastolic Dysfunction to Pulmonary Hypertension Complicating Chronic Systolic Heart Failure
J Am Coll Cardiol Img, 2011; 4:946-954
Results: Criteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP 45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e' ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA 20 mm2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e' ratio 15, odds ratio: 3.31, p < 0.001; DT 150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e' ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001).
Conclusions: Patients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension.
Artigo demonstra correlação clara entre a diástole do VE e o achado de hipertensão pulmonar acentuada.
Editorial valoriza o achado, pois onde há represamento, certamente haverá elevação das pressões.