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標題: | 吸入式Iloprost對於保留性收縮分率心衰竭病人之運動血液動力學及心室表現之影響 Inhaled Iloprost, Exercise Hemodynamics, and Ventricular Performance in Heart Failure with Preserved Ejection Fraction–the ILO-HOPE trial |
作者: | Jen-Fang Cheng 鄭人方 |
指導教授: | 林亮宇(Lian-Yu Lin) |
關鍵字: | 保留性收縮分率心衰竭,血液動力學,運動負荷試驗,組織都卜勒影像,整體縱向形變,iloprost, heart failure with preserved ejection fraction,hemodynamics,iloprost,exercise stress test,tissue Doppler imaging,global longitudinal strain, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 目的: 在保留性收縮分率心衰竭之病人,可觀察到運動時的肺微血管楔壓會顯著的上升。Iloprost是一種前列環素類似物,而前列環素路徑為造成肺動脈高壓之成因之一。此研究設計希望知道吸入式iloprost是否可增進病人之運動血液動力學及心臟儲備力。
方法: 此篇研究為雙盲隨機、安慰劑控制、平行設計之臨床試驗。共收錄34位保留性收縮分率心衰竭之病人。本研究將病人隨機分至兩組,分別接受iloprost及安慰劑治療,且於用藥前後的休息時及運動時,接受心導管檢查、呼出氣體檢測分析及二維心臟超音波檢查。主要評估指標為運動肺微血管楔壓之下降。高解析心臟超音波檢查包含左心室縱向形變、左心室舒張功能及右心室功能。 結果: 研究結果觀察到病人在運動時,肺微血管楔壓上升(from 16 (range, 14-23) mmHg to 27 (21-36) mmHg; p<0.0001)。與安慰劑相比,使用吸入式iloprost後,運動肺微血管楔壓明顯下降(adjusted mean: 20 (16-29) mmHg vs. 23 (17-32) mmHg; p = 0.002)。兩組之間的運動心輸出儲備並無顯著差異(0.2 (–1.3 - 1.2) L/min vs. –0.7 (–1.9 - 0.1) L/min; p=0.099)。與安慰劑相比,吸入式iloprost改善保留性收縮分率心衰竭病人運動時肺動脈壓與血流之關係。運動時,Iloprost組別的左心室整體縱向形變較明顯(-24.96 ± 1.20 vs. -20.75 ± 3.00, p<0.001),左心室整體縱向形變改變量亦較大(+6.02 ± 1.39 vs. +3.44 ± 0.80, p<0.001)。此外,使用iloprost也與改善運動時的左心室舒張功能及右心室收縮功能相關。 結論: 吸入式iloprost對於保留性收縮分率心衰竭之病人可有效增進運動時的血液動力學缺損。應進一步設計前瞻性臨床試驗研究iloprost之長期效能。 Aims: A dramatic increase in pulmonary capillary wedge pressure (PCWP) during exercise is observed in patients with heart failure with preserved ejection fraction (HFpEF). The prostacyclin pathway is involved in pulmonary hypertension and iloprost is a prostacyclin analogue. This study was designed to determine whether iloprost inhalation could improve exercise hemodynamics and cardiac reserve in patients with HFpEF. Methods: Thirty-four HFpEF patients were enrolled in this double-blind, randomized, placebo-controlled, parallel-group trial. Patients received both cardiac catheterization and underwent expired gas analysis at rest, during exercise, and before and 15 minutes after treatment with either inhaled iloprost or placebo. The primary endpoint was decrease in exercise PCWP. In addition, two-dimensional transthoracic echocardiography with high temporal resolution was implemented to measure LV longitudinal strain, LV diastolic function and RV function both at rest and during supine exercise. Results: At baseline, enrolled patients showed an increase in PCWP during exercise (from 16 (range, 14-23) mmHg to 27 (21-36) mmHg; p<0.0001). After iloprost inhalation, exercise PCWP was significantly reduced compared to placebo (adjusted mean: 20 (16-29) mmHg vs. 23 (17-32) mmHg; p = 0.002). There was no difference for cardiac output reserve with exercise in two groups (0.2 (–1.3 - 1.2) L/min vs. –0.7 (–1.9 - 0.1) L/min; p=0.099). Iloprost improved the pulmonary artery pressure flow relationships in HFpEF with exercise compared to placebo. Left ventricular global longitudinal strain (LV GLS) during exercise increased more in iloprost group (LV GLS, -24.96 ± 1.20 vs. -20.75 ± 3.00, p<0.001). Iloprost also resulted in greater increment of LV GLS when exercise (ΔLV GLS, +6.02 ± 1.39 vs. +3.44 ± 0.80, p<0.001). Moreover, iloprost was associated with improvement of LV diastolic function, RV systolic function and pulmonary hypertension during exercise Conclusions: Iloprost inhalation improved hemodynamic deficits and myocardial performance during exercise in patients with HFpEF. Prospective trials testing long-term iloprost therapy in this population are warranted. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/52443 |
DOI: | 10.6342/NTU202002572 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床醫學研究所 |
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