Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging.
Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging.
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DOI：
10.1186/s40064-016-2755-7
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Watanabe H
中科院分区：
文献类型：
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作者：
Odagiri K;Inui N;Hakamata A;Inoue Y;Suda T;Takehara Y;Sakahara H;Sugiyama M;Alley MT;Wakayama T;Watanabe H
最近，时间分辨 3D 相衬磁共振成像（4D-flow）可以测量肺动脉高压患者的血流动力学。异常的血流动力学，例如肺动脉（PA）中的涡流血流模式，可能反映肺动脉高压（PAH）的进展。一些报告表明，包括壁剪切应力（WSS）在内的异常血流参数可能是 PAH 的标志。然而，尚未充分评估这些变量的临床用途。我们的目的是评估这些流动动力学参数，例如涡流形成时间（VFT）和WSS，是否与右心室（RV）功能相关。 15 名受试者（其中 9 名患有 PAH 患者和 6 名健康志愿者）接受了 4D 流程。评估PAH患者和健康志愿者之间血流模式、血流速度和WSS的差异。我们还评估了 PAH 患者的 VFT、WSS 和 RV 功能之间的关联。在所有 PAH 患者中均观察到主 PA 中的涡流血流模式和早期收缩期逆行血流。 PAH 患者的 PA 流速和 WSS 低于健康志愿者，但 MPA、RPA 和 LPA 中的血流量以及 MPA 中的 SV 在各组之间大致相当。平均 VFT 为心动周期的 35.0 ± 16.6%。 VFT 与 RV 射血分数、RV 收缩末期容积和 RV 收缩末期容积指数显着相关（RVEF = 75.1 + (−85.7)·VFT，p = 0.003，RVESV = 12.4 + 181.8·VFT，p = 0.037 和PAH 患者的 RVESVI = 10.6 + 114.8·VFT，p = 0.038，分别）， 而 WSS 与 RV 功能无关。我们证实异常的血流动力学，包括涡流形成和逆行血流的早期出现、PA 中的低 WSS 是 PAH 的特征。 VFT 可能与右心室功能障碍有关，而 WSS 则不然。我们的结果表明 4D 流是检测右心衰竭和诊断 PAH 的有效方法。临床试验注册网址：https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi。唯一标识符：UMIN000011128 本文的在线版本 (doi:10.1186/s40064-016-2755-7) 包含补充材料，可供授权用户使用。
Recently, time-resolved 3D phase contrast magnetic resonance imaging (4D-flow) allows flow dynamics in patients with pulmonary arterial hypertension to be measured. Abnormal flow dynamics, such as vortex blood flow pattern in the pulmonary artery (PA), may reflect progression of pulmonary arterial hypertension (PAH). Some reports suggested that abnormal blood flow parameters including wall shear stress (WSS) could be markers of PAH. However, it was not fully assessed clinical usefulness of these variables. We aimed to assess whether these flow dynamic parameters, such as vortex formation time (VFT) and WSS, were associated with right ventricular (RV) function. Fifteen subjects, nine with PAH and six healthy volunteers, underwent 4D-flow. Differences of Blood flow patterns, blood flow velocities and WSS between PAH patients and healthy volunteers were evaluated. We also assessed the association between VFT, WSS and RV function in PAH patients. Both vortex blood flow patterns and early systolic retrograde flow in the main PA were observed in all patients with PAH. The PA flow velocities and WSS in patients with PAH were lower than those in healthy volunteers, but that blood flow volumes in the MPA, RPA and LPA and SV in the MPA were broadly comparable between the groups. The mean VFT was 35.0 ± 16.6 % of the cardiac cycle. The VFT significantly correlated with RV ejection fraction, RV end systolic volume, and RV end systolic volume index (RVEF = 75.1 + (−85.7)·VFT, p = 0.003, RVESV = 12.4 + 181.8·VFT, p = 0.037 and RVESVI = 10.6 + 114.8·VFT, p = 0.038, respectively) in PAH patients, whereas WSS did not correlate with RV function. We confirmed that abnormal blood flow dynamics, including the vortex formation and the early onset of retrograde flow, low WSS in the PA were characteristics of PAH. The VFT may be associated with right ventricular dysfunction, whereas WSS was not. Our results suggest that 4D-flow is an effective means of detecting right heart failure as well as diagnosing PAH. Clinical trial registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi. Unique identifier: UMIN000011128 The online version of this article (doi:10.1186/s40064-016-2755-7) contains supplementary material, which is available to authorized users.