Increased Right Ventricular Fatty Acid Accumulation in Chronic Thromboembolic Pulmonary Hypertension.
Increased Right Ventricular Fatty Acid Accumulation in Chronic Thromboembolic Pulmonary Hypertension.
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DOI：
10.1513/annalsats.201504-236le
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发表时间：
2015-10
影响因子：
8.3
通讯作者：
S. Sakao;Hideyuki Miyauchi;N. Voelkel;T. Sugiura;N. Tanabe;Yoshio Kobayashi;K. Tatsumi
中科院分区：
文献类型：
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作者：
S. Sakao;Hideyuki Miyauchi;N. Voelkel;T. Sugiura;N. Tanabe;Yoshio Kobayashi;K. Tatsumi
右室肥厚合并重度肺动脉高压(PH)时，能量代谢向糖酵解转变。关于PH合并右室肥厚患者的脂肪酸代谢的研究很少。目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者肥厚的右室是否存在脂肪酸蓄积，以及这种蓄积是否与右心导管术获得的血流动力学参数有关。方法应用~(123)I-β-甲基碘苯基十五烷酸(123I-BMIPP)模拟显像法，对16例正常对照组和13例慢性阻塞性肺疾病患者(13例)肺血栓内膜剥脱术前、后右室内脂肪蓄积情况进行研究。测量和主要结果显示，CTEPH患者在肺内膜切除术前右室摄取~(123)I-BMIPP增加。血栓内膜剥脱术后右室摄取~(123)I-BMIPP显著降低(P=0.003)，并伴有血流动力学指标的改变。右室BMIPP摄取与平均肺动脉压显著相关(r=0.51，P=0.0228)，与肺血管阻力无关(r=0.39，P=0.0932)。结论首次应用~(123)I-BMIPP摄取显像显示CTEPH患者右室内脂肪酸蓄积，且这种蓄积是可逆的。这项研究表明，这种成像方式可能有助于监测重度PH患者的右室代谢功能。
RATIONALE In right ventricular hypertrophy associated with severe pulmonary hypertension (PH), a shift of energy metabolism toward glycolysis occurs. There are few investigations regarding fatty acid metabolism in patients with PH and right ventricular hypertrophy. OBJECTIVES To assess whether there is fatty acid accumulation in the hypertrophied right ventricle in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to determine whether this accumulation is related to hemodynamic variables obtained by right heart catheterization. METHODS To assess fatty acid accumulation in the right ventricle, 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP) analog imaging was performed in control subjects (n=16) and patients with CTEPH (n=13) before (n=13) and after (n=8) pulmonary thromboendarterectomy. MEASUREMENTS AND MAIN RESULTS There was increased 123I-BMIPP uptake in the right ventricle of subjects with CTEPH before pulmonary endarterectomy. Right ventricular 123I-BMIPP uptake decreased significantly after thromboendarterectomy (P=0.003) in parallel with the change of hemodynamic variables. The right ventricular BMIPP uptake was significantly correlated with the mean pulmonary artery pressure (r=0.51, P=0.0228) but not with pulmonary vascular resistance (r=0.39, P=0.0932). CONCLUSIONS This is the first study that uses 123I-BMIPP uptake imaging to show that fatty acid accumulates in the right ventricle of patients with CTEPH and that the increased accumulation is reversible after pulmonary thromboendarterectomy. This study suggests that this imaging modality may be useful for monitoring right ventricle metabolic functions in severe PH.