Cardiac Magnetic Resonance Imaging-Based Right Ventricular Strain Analysis for Assessment of Coupling and Diastolic Function in Pulmonary Hypertension
Cardiac Magnetic Resonance Imaging-Based Right Ventricular Strain Analysis for Assessment of Coupling and Diastolic Function in Pulmonary Hypertension
复制标题
DOI：
10.1016/j.jcmg.2018.12.032
复制
发表时间：
2019-11-01
影响因子：
14
通讯作者：
Richter, Manuel J.
中科院分区：
文献类型：
--
作者：
Tello, Khodr;Dalmer, Antonia;Richter, Manuel J.
本研究旨在比较心脏磁共振（CMR）成像衍生的右心室（RV）应变和侵入性测量的压力-容积环衍生的RV收缩力，刚度，和后负荷和RV-动脉耦合在肺动脉高压（PH）。背景在慢性RV压力超负荷，RV-动脉解耦合被认为是RV适应不良和最终RV失败的驱动原因。CMR衍生的RV应变的病理生理和临床价值相对于有创压力-容积环衍生测量PH仍然不完全understood.METHODS在38例PH患者，全球RV CMR应变测量24小时内诊断右心导管和电导（压力-容积）导管。结果右心室长轴纵向和径向应变及短轴径向和周向应变分别为-18.0 +/-7.0%，28.9%，15.6 +/-6.2%，28.9%[四分位距（IQR）：17.4%~ 46.6%];和-9.8 +/-3.5%。RV-动脉耦合（收缩末期[Eds]/动脉弹性[Ea]）为0.76（IQR：0.47 - 1.07）。RV峰值应变与Ees/Ea、后负荷（Ea）、RV舒张功能障碍（Tau）和僵硬度（舒张末期弹性[Eed]）相关，但与收缩力（Ees）无关。在多变量分析中，长轴RV径向应变与RV-动脉解偶联相关（Ees/Ea：= 0.124 mm Hg/ml; OR：1.23; 95% CI：1.10 - 1.51）。右心室长轴纵向应变与右心室舒张末期容积/体表面积比值强有力地预测了右心室舒张僵硬度（受试者工作特征曲线下面积：结论：在慢性右心室负荷过重时，CMR测定的RV应变与RV动脉解偶联和RV舒张末期僵硬度相关，代表了当前评估RV动脉偶联和舒张末期僵硬度的有创方法的一种有前景的无创替代方法。PH患者的舒张期僵硬度。（C）2019由美国心脏病学会基金会。
OBJECTIVES This study sought to compare cardiac magnetic resonance (CMR) imaging-derived right ventricular (RV) strain and invasively measured pressure-volume loop-derived RV contractility, stiffness, and afterload and RV-arterial coupling in pulmonary hypertension (PH).BACKGROUND In chronic RV pressure overload, RV-arterial uncoupling is considered the driving cause of RV maladaptation and eventual RV failure. The pathophysiological and clinical value of CMR-derived RV strain relative to that of invasive pressure-volume loop-derived measurements in PH remains incompletely understood.METHODS In 38 patients with PH, global RV CMR strain was measured within 24 h of diagnostic right heart catheterization and conductance (pressure-volume) catheterization. Associations were evaluated by correlation, multivariate logistic binary regression, and receiver operating characteristic analyses.RESULTS Long-axis RV longitudinal and radial strain and short-axis RV radial and circumferential strain were -18.0 +/- 7.0%, 28.9% [interquartile range (IQR): 17.4% to 46.6%]; 15.6 +/- 6.2%; and -9.8 +/- 3.5%, respectively. RV-arterial coupling (end-systolic [Eds]/arterial elastance [Ea]) was 0.76 (IQR: 0.47 to 1.07). Peak RV strain correlated with Ees/Ea, afterload (Ea), RV diastolic dysfunction (Tau), and stiffness (end-diastolic elastance [Eed]) but not with contractility (Ees). In multivariate analysis, long-axis RV radial strain was associated with RV-arterial uncoupling (Ees/Ea: = 0.124 mm Hg/ml; OR: 1.23; 95% CI: 1.10 to 1.51). The long-axis RV longitudinal strain-to-RV end-diastolic volume/body surface area ratio strongly predicted RV diastolic stiffness (area under receiver operating characteristic curve: 0.908).CONCLUSIONS In chronic RV overload, CMR-determined RV strain is associated with RV-arterial uncoupling and RV end-diastolic stiffness and represents a promising noninvasive alternative to current invasive methods for assessment of RV-arterial coupling and end-diastolic stiffness in patients with PH. (C) 2019 by the American College of Cardiology Foundation.