Clinical Analysis Of Pulmonary Hypertension

Objective:This part of the study aims to analyze the correlation between the severity of pulmonary hypertension(PAH)and the levels of various serum markers in PAH patients,including mean platelet volume(MPV),amino terminal pro brain natriuretic peptide(NT-pro BNP),uric acid(UA),endothelin-1(ET-1)and D-dimer(D-D).Methods:From January 2013 to December 2016,we included530 patients who were diagnosed pulmonary arterial hypertension by right heart catheterization the treatment center for pulmonary vascular disease of Fowey Hospital.General information,the levels of serum markers,data of echocardiography and right heart catheterization indicators of these patients were carefully collected for baseline data analysis.Subsequently,the patients were divided into three group(mild,moderate and severe groups)according to the severity of their disease,which was measured by the mean pulmonary artery pressure.The levels of serum markers between each group were compared bySpearman;The data obtained from ultrasound examination and right heart catheterization were also analyzed.Results:According to the data of right heart catheterization,the rank of the proportion of different clinical classification in 530 PAH patients was as follows:idiopathic pulmonary hypertension,congenital heart disease related pulmonary hypertension,chronic thrombo embolic pulmonary hypertension,connective tissue disease associated pulmonary hypertension,hypoxic pulmonary hypertension.In this study,the serum levels of MPV,UA,ET-1,NT-pro BNP in patients with mild,moderate and severe degree of pulmonary arterial hypertension were significantly different.Moreover,with the increase of mean pulmonary arterial pressure,the levels of these serum markers elevated,which was statistically significant The serum levels of MPV,UA,ET-1,NT-pro,BNP were positively correlated with pulmonary artery systolic pressure,pulmonary diastolic pressure,mean pulmonary arterial pressure and pulmonary vascular resistance.D-D was also significantly positively associated with pulmonary vascular resistance.Conclusion:Based on data of right heart catheterization from our center,idiopathic pulmonary hypertensionpatients accounts for the highest proportion in patients with pulmonary hypertension.The levels of MPV,UA,ET-1 and NT-proBNP were positively correlated to the severity of pulmonary arterial hypertension.D-D was positively correlated to pulmonary vascular resistance.These differences were statistically significant.Objective:The objective of this part of the study is to analyze the association between systolic pulmonary artery pressure measured by echocardiography and systolic pulmonary artery pressure measured by right cardiac catheterization.Methods:We recruited 530 patients diagnosed with PAH by right heart catheterization from January 2013 to December 2016 in our hospital.All patients were examined by echocardiography and right heart catheterization.Data were collected and the correlation was detected by linear regression analysis.Results:The pulmonary artery systolic pressure measured by ultrasound was positively related to the systolic pressure of the pulmonary artery measured by the right heart catheter by linear analysis,and the correlation coefficient was 0.284(p<0.05).According to the ultrasonic SPAP value,the patients were divided into three groups:group A(SPAP100mmHg),group B(SPAP),group C(SPAP60mmHg).The correlation relationship between the three groups and pulmonary artery systolic pressure measured by catheterwas analyzed by linear correlation analysis.The result indicated that when the SPAP was higher than100mmHg,the correlation coefficient of pulmonary artery systolic pressure detected by right heart catheter was remarkably higher than that group B.However,when SPAP was lower than 60mmHg,there was no significant correlation between these two indicators.The SPAP measured by ultrasound and catheter were positively correlated with a correlation coefficient of 0.523(p<0.01);SPAP measured by ultrasound was positively associated withdPAP,mPAP and SVRdetermined by catheter(p<0.01);Furthermore,left ventricular diastolic diameter and sPAP,dPAP,mPAP were negatively correlated(p<0.01);acute pulmonary vasodilator testing was negatively correlatied with SPAP,right ventricular end diastolic anteroposterior diameter(p<0.05).Conclusion:the pulmonary artery systolic pressure measured by ultrasound had a positive correlation with the pulmonary artery systolic pressure measured by the right heart catheter,and the correlation coefficient increased as the pulmonary artery systolic pressure elevated.Objective:This part of the study aims to analyze the serum markers of connective tissue disease associated pulmonary arterial hypertension,including platelet distribution volume,red cell distribution width,serum uric acid analysis and indicators obtained from ultrasound examination and right heart catheterization.Methods:From January 2013 to December 2016,we enrolled 53 connective tissue disease related PAH patients diagnosed by right heart catheterization in Fuwai Hospital.General information,serum markers,data of ultrasonic cardiogram and right heart catheterization were collected.The participants were divided in to mild-moderate and severe groups according to the degree of their mean pulmonary mean pressure.The levels of serum markers between these two groups were compared;According to the WHO classification,pulmonary arterial hypertension was divided into functional class ?-? and class ?-?,the comparison between the serum markers of the two groups was conducted;the analysis of the association between serum markers and ultrasound data as well as right heart catheterization was performed.Results:compared with the mild-moderate pulmonary hypertension group,the levels of MPV,UA and NT-proBNP were significantly higher in participants ofsevere pulmonary arterial hypertension group.Correlation analysis resultswere as follows:ESR was positively related to left ventricular end diastolic diameter,and negatively correlated with SPAP.UA and TAPSE were negatively correlated while positively correlated with cardiothoracic ratio.NT-proBNP was positively related with three tricuspid regurgitation pressure,right ventricular end diastolic diameter.TAPSEand the left ventricular end diastolic period the size is negatively related.ET was positively correlated with diastolic period;and the diameter of right ventricle,three tricuspid regurgitation velocity,cardiothoracic ratio.MPV and sPAP,dPAP,mPAP,PVR,sPAP and UA positive correlation;dPAP,mPAP,PVR and NT-proBNP were positively related;the average right ventricular pressure,PVR were positively correlated and negatively correlated with systemic blood flow and 6MWD;ET-1 and mean right ventricular pressure was positively correlated with the Brog score;pulmonary blood flow,blood circulation flow,heart index negative correlation.Conclusion:MPV,UA and NT-proBNP wereassociated with connective tissue disease related pulmonary hypertension and the severity of the disease.