Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging.
Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging.
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DOI：
10.1007/s00330-017-5143-y
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发表时间：
2018-04
影响因子：
5.9
通讯作者：
Swift AJ
中科院分区：
文献类型：
--
作者：
Johns CS;Rajaram S;Capener DA;Oram C;Elliot C;Condliffe R;Kiely DG;Wild JM;Swift AJ
肺动脉高压（PH）与慢性阻塞性肺疾病（COPD）的不良预后相关，并具有侵入性诊断。我们旨在评估无创心血管磁共振（CMR）模型的诊断准确性和预后价值。COPD合并疑似PH患者行CMR和右心导管（RHC）治疗。评估三种候选模型：1、CMR-RV模型，基于右心室（RV）质量和室间隔角；2、CMR PA/RV包括RV肿块、间隔角和肺动脉（PA）测量；3、Alpha指数，基于RV射血分数和PA大小。CMR-PA/RV模型诊断准确率最高（敏感性92%，特异性80%，阳性预测值96%，阴性预测值63%，AUC 0.93, p<0.0001）。将RHC-mPAP、CMR-RV和CMR-PA/RV模型拆分35mmHg，生存率差异有统计学意义，对数秩卡方分别为5.03、5.47和7.10。多因素Cox回归结果显示，左心室质量和左心室相对面积变化是死亡率的独立预测因子（p=0.002和0.030）。CMR提供了PH-COPD的诊断和预后信息。CMR-PA/RV模型可用于诊断，RV质量指数和PA相对面积变化可用于评估预后。•肺动脉高压是COPD预后不良的标志。•MRI可以预测有创测量的平均肺动脉压。•心脏MRI可用于COPD患者的生存评估。•心脏MRI可能对随访或未来的试验有用。•MRI对评估COPD患者的肺动脉高压有潜在的作用。
Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models. Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size. Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030). CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis. • Pulmonary hypertension is a marker of poor outcome in COPD. • MRI can predict invasively measured mean pulmonary artery pressure. • Cardiac MRI allows for estimation of survival in COPD. • Cardiac MRI may be useful for follow up or future trials. • MRI is potentially useful to assess pulmonary hypertension in patients with COPD.
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影响因子：
24
作者：
Hoeper, Marius M.;Lee, Stephen H.;Rubin, Lewis J.
通讯作者：
Rubin, Lewis J.
影响因子：
8.9
作者：
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通讯作者：
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影响因子：
3.3
作者：
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通讯作者：
Van Beek, EJR
影响因子：
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作者：
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通讯作者：
CASTANER, A
影响因子：
3.3
作者：
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通讯作者：
Schad, Lothar R.