Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure
Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure
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DOI：
10.1186/s12880-020-00428-9
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发表时间：
2020-03-06
影响因子：
2.7
通讯作者：
Ugander, Martin
中科院分区：
文献类型：
--
作者：
Ramos, Joao G.;Fyrdahl, Alexander;Ugander, Martin
背景肺动脉高压是通过右心导管测量平均肺动脉压（mPAP）来确诊的。心血管磁共振（CMR）四维（4D）血流分析可以从PA中的血流涡旋持续时间估计mPAP，结果非常好。此外，通过多普勒超声心动图测量的收缩期三尖瓣反流（TR）峰值压力梯度（TRPG）通常用于临床常规，以估计收缩期PA压力。本研究旨在比较CMR和超声心动图在定量和分类一致性以及检测PA压力升高的诊断率方面的差异。方法对60例临床转诊患者（n = 60，中位[四分位距]年龄60 [48-68]岁，33%为女性）在1.5T（n = 43）或3 T（n = 17）下进行超声心动图和CMR。使用市售的时间分辨多个2D切片相位对比三向速度编码序列（覆盖主PA），使用PA涡流持续时间估计mPAP。进行经胸多普勒超声心动图测量TR并推导TRPG。诊断率定义为CMR或超声心动图检测到PA压力升高的病例比例，定义为涡流持续时间≥ 15%心动周期（mPAP ≥ 25 mmHg）或TR速度> 2.8 m/s（TRPG > 31 mmHg）。结果60例患者中39例（65%）CMR和超声心动图均显示PA压力正常，9例（15%）PA压力升高，总体符合率为80%（48/60），Kappa值为0.49（95%可信区间0.27-0.71）。CMR检测PA压力升高的诊断率高于超声心动图（21/60（35%）vs 9/60（15%），p < 0.001）。在可观察到PA涡旋和可测量TR速度的病例中（34/60，56%），TRPG与mPAP相关（R-2 = 0.65，p < 0.001）。结论CMR估测的mPAP与超声心动图估测的TRPG具有良好的定量和分类一致性。与超声心动图相比，CMR检测PA压力升高的诊断率更高，可能是由于超声心动图检测PA压力升高的灵敏度低于CMR，这与超声心动图充分可视化和测量TR射流的能力有限有关。超声心动图、CMR和侵入性测量之间的未来比较是合理的，以明确证实这些结果。
Background Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods Consecutive clinically referred patients (n = 60, median [interquartile range] age 60 [48-68] years, 33% female) underwent echocardiography and CMR at 1.5 T (n = 43) or 3 T (n = 17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration >= 15% of the cardiac cycle (mPAP >= 25 mmHg) or TR velocity > 2.8 m/s (TRPG > 31 mmHg). Results Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p < 0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R-2 = 0.65, p < 0.001). Conclusions There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.