Pulmonary Artery Hypertension-Specific Therapy Improves Exercise Tolerance and Outcomes in Exercise-Induced Pulmonary Hypertension

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K09506
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: The University of Tokushima
• Principal Investigator: KUSUNOSE Kenya 徳島大学, 病院, 助教 (70507649)
• Co-Investigator(Kenkyū-buntansha): 山田 博胤 徳島大学, 大学院医歯薬学研究部(医学域), 特任教授 (40380084) ; 西尾 進 徳島大学, 病院, 臨床検査技師 (90747841)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: 肺高血圧 / 心不全 / 心エコー

Outline of Final Research Achievements

Objectives: We sought (1) to assess the long-term clinical course in patients at risk and (2) to evaluate whether vasodilator therapy improved pulmonary vascular response, exercise capacity and prognosis in exercise induced pulmonary hypertension (EIPH). Methods and Results: We prospectively performed 6 minute-walk stress echocardiographic studies in 243 scleroderma or mixed connective tissue disease patients with scleroderma features. EIPH was observed in 57 patients, and non-EIPH was observed in 186 patients. Of 57 patients with EIPH, 29 patients underwent supine exercise right heart catherization with bicycle ergometer to peak exercise. After one year of treatment, there was a significant decrease in ΔmPAP/ΔCO, with a trend of increasing 6MWD in the treatment group (n=14) compared with the control group (n=15). Conclusions: After pulmonary vasodilator therapy, pulmonary circulation and prognosis improved in patients with EIPH.

Free Research Field

心血管画像

Academic Significance and Societal Importance of the Research Achievements

肺高血圧症診療において，ハイリスク患者をモニタリングし，肺動脈床異常を示す患者を治療することは重要である．6分間歩行負荷心エコー図検査によりΔmPAP/ΔQが算出可能であるが，本研究によりこの指標に基づいた治療介入の臨症上の効果を証明することができた．
6分間歩行負荷心エコー図検査によるリスク層別化は治療介入に役立ち，患者の治療戦略の決定に重要な情報を提供するだけでなく，多くの施設で治療効果の判定，患者予後の改善のために利用できる．今後，運動誘発性肺高血圧というハイリスク患者を見落とさないようにするため，本手法の効果的な広報および利用が望まれる．