Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study
Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study
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DOI：
10.1007/s10554-016-0985-y
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发表时间：
2017-02
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通讯作者：
Y. Yamasaki;M. Nagao;K. Abe;K. Hosokawa;S. Kawanami;T. Kamitani;T. Yamanouchi;K. Horimoto;H. Yabuuchi;H. Honda
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作者：
Y. Yamasaki;M. Nagao;K. Abe;K. Hosokawa;S. Kawanami;T. Kamitani;T. Yamanouchi;K. Horimoto;H. Yabuuchi;H. Honda
目的：利用心脏磁共振成像（MRI）研究球囊肺血管成形术（BPA）对无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者室间非同步化及其与心室相互作用的关系。这项前瞻性观察性研究得到了我们机构审查委员会的批准。对20例CTEPH患者在BPA治疗前和BPA治疗后随访时进行心脏MRI和右心导管检查。我们使用MRI测量了右心室（RV）和左心室（LV）舒张末期容积（EDV）、收缩末期容积（ESV）、卒中容积（SV）和射血分数（EF）。对于左室和右室自由壁，计算周向应变峰值时间（Tpeak）作为室间非同步化的参数。BPA处理后，RV-EDV和-ESV显著降低，RVEF显著升高。相反，BPA在不改变LVESV的情况下显著增加LV EDV和SV。tpeak应变左至右自由壁延迟（L-R延迟）由105±44 ms降至47±67 ms （p < 0.001）。左室EDV （r = 0.65, p < 0.01）、SV （r = 0.74, p < 0.001）和6分钟步行距离（6MWD） （r = 0.54, p < 0.05）增加与L-R延迟减少相关。在不能手术的CPEPH患者中，BPA改善了室间不同步运动，这与SV和6MWD的增加密切相关。利用心脏MRI评估室间非同步化运动在评估心室相互作用中具有重要作用，从而降低LVSV和运动耐量。
To use cardiac magnetic resonance imaging (MRI) to investigate the effect of balloon pulmonary angioplasty (BPA) on interventricular dyssynchrony and its associations with ventricular interaction, which impairs LV function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This prospective observational study was approved by our institutional review board. Cardiac MRI and right heart catheterization were conducted before BPA sessions and at the follow up after BPA in 20 patients with CTEPH. We measured right ventricular (RV) and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using MRI. For the LV and RV free walls, the time to peak (Tpeak) of circumferential strain was calculated as a parameter for interventricular dyssynchrony. Following BPA, the RV-EDV and -ESV were significantly decreased, and the RVEF was significantly increased. Conversely, BPA led to significantly increased LV EDV and SV without changing LVESV. The left-to-right free wall delay (L–R delay) in Tpeakstrain decreased from 105 ± 44 ms to 47 ± 67 ms (p < 0.001). Increased LV EDV (r = 0.65, p < 0.01), SV (r = 0.74, p < 0.001) and 6-minute walk distance (6MWD) (r = 0.54, p < 0.05) were correlated to the reduction in L–R delay. In patients with inoperable CPEPH, BPA improved interventricular dyssynchrony, which was strongly associated with increased SV and 6MWD. The assessment of interventricular dyssynchrony using cardiac MRI has an important role in evaluating ventricular interaction, which reduces LVSV and exercise tolerance.