Background: Patients with combined post- and precapillary pulmonary hypertension due to left heart disease have a worse prognosis compared with isolated postcapillary. However, it remains unclear whether increased mortality in combined post- and precapillary pulmonary hypertension is simply a result of higher total right ventricular load. Pulmonary effective arterial elastance (Ea) is a measure of total right ventricular afterload, reflecting both resistive and pulsatile components. We aimed to test whether pulmonary Ea discriminates survivors from nonsurvivors in patients with pulmonary hypertension due to left heart disease and if it does so better than other hemodynamic parameters associated with combined post- and precapillary pulmonary hypertension.

Methods and Results: We combined 3 large heart failure patient cohorts (n=1036) from academic hospitals, including patients with pulmonary hypertension due to heart failure with preserved ejection fraction (n=232), reduced ejection fraction (n=335), and a mixed population (n=469). In unadjusted and 2 adjusted models, pulmonary Ea more robustly predicted mortality than pulmonary vascular resistance and the transpulmonary gradient. Along with pulmonary arterial compliance, pulmonary Ea remained predictive of survival in patients with normal pulmonary vascular resistance. The diastolic pulmonary gradient did not predict mortality. In addition, in a subset of patients with echocardiographic data, Ea and pulmonary arterial compliance were better discriminators of right ventricular dysfunction than the other parameters.

Conclusions: Pulmonary Ea and pulmonary arterial compliance more consistently predicted mortality than pulmonary vascular resistance or transpulmonary gradient across a spectrum of left heart disease with pulmonary hypertension, including patients with heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, and pulmonary hypertension with a normal pulmonary vascular resistance.

中文翻译：

---

肺有效动脉弹性作为右心室后负荷的测量及其对左心病引起的肺动脉高压的预后价值

背景：由于左心疾病而合并毛细血管后和毛细血管前肺动脉高压的患者与单纯毛细血管后肺动脉高压患者相比，预后较差。然而，目前尚不清楚毛细血管后和前肺动脉高压死亡率的增加是否仅仅是右心室总负荷较高的结果。肺有效动脉弹性（Ea）是衡量右心室总后负荷的指标，反映阻力成分和搏动成分。我们的目的是测试肺 Ea 是否能够区分左心病肺动脉高压患者的幸存者和非幸存者，以及它是否比与毛细血管后和毛细血管前合并肺动脉高压相关的其他血流动力学参数更好。

方法和结果：我们合并了来自学术医院的 3 个大型心力衰竭患者队列 (n=1036)，其中包括因心力衰竭导致射血分数保留 (n=232)、射血分数降低 (n=335) 和射血分数降低 (n=335) 的心力衰竭患者。混合人群 (n=469)。在未调整和 2 个调整模型中，肺 Ea 比肺血管阻力和跨肺梯度更能预测死亡率。与肺动脉顺应性一样，肺 Ea 仍然可以预测肺血管阻力正常的患者的生存情况。肺舒张压梯度不能预测死亡率。此外，在具有超声心动图数据的患者子集中，Ea 和肺动脉顺应性比其他参数更能区分右心室功能障碍。

结论：在一系列伴有肺动脉高压的左心疾病中，包括射血分数保留的心力衰竭、射血分数降低的心力衰竭和肺动脉高压患者，肺 Ea 和肺动脉顺应性比肺血管阻力或跨肺梯度更能一致地预测死亡率。肺血管阻力正常。