循環器ジャーナル66巻3号

2018年07月発行

特集 肺高血圧症Cutting Edge Ⅴ．肺高血圧症のトピックスあるいはコントラバーシ

治療効果判断や予後予測の評価指標に何を用いるべきか？—6MWD，mPAP or sPAP，複合指標？

著者： 山本浩司¹ 武田裕²

所属機関： ¹名古屋市立大学病院循環器内科 ²NTT西日本東海病院

ページ範囲：P.438 - P.442

Point
・肺高血圧症における予後予測は容易ではない．現在は複数の指標を組み合わせて総合的判断をすることが推奨されている．
・これまでに得られた知見の多くが，特発性/遺伝性肺動脈性肺高血圧症を対象としたものであり，他の臨床分類の肺高血圧症に応用できるかどうかは今後の課題である．

参考文献

1) Nickel N, Golpon H, Greer M, et al:The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension. Eur Respir J 39:589-596, 2012

2) Yamamoto K, Takeda Y, Takeda Y, et al:Long-term survival of patients with pulmonary arterial hypertension recovering to World Health Organization functional class Ⅰ or Ⅱ:a historical comparison between intravenous epoprostenol and oral agents. BMC Res Notes 7:359, 2014

3) Miyamoto S, Nagaya N, Satoh T, et al:Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487-492, 2000

4) Savarese G, Paolillo S, Costanzo P, et al:Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension?:a meta-analysis of 22 randomized trials. J Am Coll Cardiol 60:1192-1201, 2012

5) Galie N, Humbert M, Vachiery JL, et al:2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology（ESC）and the European Respiratory Society（ERS）:Endorsed by:Association for European Paediatric and Congenital Cardiology（AEPC）, International Society for Heart and Lung Transplantation（ISHLT）. Eur Heart J 37:67-119, 2016

6) Wensel R, Francis DP, Meyer FJ, et al:Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension. Int J Cardiol 167:1193-1198, 2013

7) Benza RL, Miller DP, Gomberg-Maitland M, et al:Predicting survival in pulmonary arterial hypertension:insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management（REVEAL）. Circulation 122:164-172, 2010

8) Mahapatra S, Nishimura RA, Sorajja P, et al:Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. J Am Coll Cardiol 47:799-803, 2006

9) Hachulla E, Clerson P, Airò P, et al:Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population. Rheumatology 54:1262-1269, 2015

10) Blumberg FC, Arzt M, Lange T, et al:Impact of right ventricular reserve on exercise capacity and survival in patients with pulmonary hypertension. Eur J Heart Fail 15:771-775, 2013

11) Vonk MC, Sander MH, van den Hoogen FH, et al:Right ventricle Tei-index:a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr 8:317-321, 2007

12) Grunig E, Tiede H, Enyimayew EO, et al:Assessment and prognostic relevance of right ventricular contractile reserve in patients with severe pulmonary hypertension. Circulation 128:2005-2015, 2013

13) van Wolferen SA, Marcus JT, Boonstra A, et al:Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28:1250-1257, 2007

14) Warwick G, Thomas PS, Yates DH:Biomarkers in pulmonary hypertension. Eur Respir J 32:503-512, 2008

15) Leuchte HH, El NM, Tuerpe JC, et al:N-terminal pro-brain natriuretic peptide and renal insufficiency as predictors of mortality in pulmonary hypertension. Chest 131:402-409, 2007

16) Savarese G, Trimarco B, Dellegrottaglie S, et al:Natriuretic peptideguided therapy in chronic heart failure:a meta-analysis of 2,686 patients in 12 randomized trials. PLoS One 8:e58287, 2013

17) Benza RL, Gomberg-Maitland M, Miller DP, et al:The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest 141:354-362, 2012