Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking.
Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking.
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DOI：
10.1186/s12968-016-0258-x
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发表时间：
2016-06-16
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影响因子：
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通讯作者：
Sanz J
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作者：
de Siqueira ME;Pozo E;Fernandes VR;Sengupta PP;Modesto K;Gupta SS;Barbeito-Caamaño C;Narula J;Fuster V;Caixeta A;Sanz J
肺动脉高压（PH）的预后与右心室（RV）功能有关。RV力学的量化可以提供附加值。本研究的目的是通过基于心血管磁共振（CMR）的特征跟踪（FT）确定RV应变分析在PH中的可行性以及临床和预后价值。我们回顾性招募了116例在1个月内接受右心导管插入术的CMR PH评估患者（年龄52.2 ± 12岁，73.6%为女性）。使用专用FT软件，从标准电影图像中量化峰值全局纵向和周向RV应变和应变率（分别为GLS、GCS、GLSR和GCSR）。使用多变量回归分析，我们评估了应变与死亡、肺移植或功能分级恶化的复合终点的相关性。RV菌株分析在110例（95%）患者中是可行的。患者分为：A组（无PH，右心室射血分数[RVEF]正常; n = 17），B组（PH，RVEF正常; n = 26），或C组（PH，RVEF异常; n = 67）。C组所有应变和应变率值均降低。此外，与A组（-1.12 [-1.3/-0.9]; p <0.001）相比，B组（-0.92 [-1.0/-0.7]; p <0.001）的GCSR显著降低。调整6个有临床意义的协变量后，GLS（风险比1.06; p = 0.026）、GLSR（风险比2.52; p = 0.04）和GCSR（风险比4.5; p = 0.01）与复合终点独立相关。GCSR成功区分了发生和未发生事件的患者（p = 0.01）。用CMR-FT定量RV毒株在大多数患者中是可行的，与疾病严重程度相关，并且与PH的不良结局独立相关。本文的在线版本（doi：10.1186/s12968 - 016 - 0258-x）包含补充材料，可供授权用户使用。
Prognosis in pulmonary hypertension (PH) is related to right ventricular (RV) function. Quantification of RV mechanics may offer additive value. The objective of our study is to determine the feasibility and clinical and prognostic value of RV strain analysis by cardiovascular magnetic resonance (CMR) based feature tracking (FT) in PH. We retrospectively enrolled 116 patients (age 52.2 ± 12 years, 73.6 % women) referred to CMR for PH evaluation who underwent right heart catheterization within 1 month. Using dedicated FT software, peak global longitudinal and circumferential RV strain and strain rates (GLS, GCS, GLSR, and GCSR, respectively) were quantified from standard cine images. Using multivariate regression analysis, we evaluated the associations of strain with a composite endpoint of death, lung transplantation, or functional class deterioration. RV strain analysis was feasible in 110 (95 %) patients. Patients were classified into: Group A (no PH, normal right ventricular ejection fraction [RVEF]; n = 17), Group B (PH, normal RVEF; n = 26), or Group C (PH, abnormal RVEF; n = 67). All strain and strain rate values were reduced in Group C. Furthermore, GCSR was significantly reduced in Group B (-0.92 [-1.0/-0.7]; p < 0.001) compared to Group A (-1.12 [-1.3/-0.9]; p < 0.001). After adjustment for six clinically meaningful covariates, GLS (hazard ratio 1.06; p = 0.026), GLSR (hazard ratio 2.52; p = 0.04), and GCSR (hazard ratio 4.5; p = 0.01) were independently associated with the composite endpoint. GCSR successfully discriminated patients with and without events (p = 0.01). Quantification of RV strain with CMR-FT is feasible in the majority of patients, correlates with disease severity, and is independently associated with poor outcomes in PH. The online version of this article (doi:10.1186/s12968-016-0258-x) contains supplementary material, which is available to authorized users.