Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment - predictors of procedure success and duration in pulmonary artery hypertension
Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment - predictors of procedure success and duration in pulmonary artery hypertension
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DOI：
10.1186/s12968-019-0569-9
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发表时间：
2019-09-09
影响因子：
6.4
通讯作者：
Coghlan, J. Gerry
中科院分区：
文献类型：
--
作者：
Knight, Daniel S.;Kotecha, Tushar;Coghlan, J. Gerry
背景心血管磁共振成像（CMR）对肺动脉高压（PAH）的诊断和治疗有重要价值，但仍需右心导管直接测量肺血流动力学。CMR引导的右心导管插入术（CMR-RHC）结合了CMR和有创心导管插入术的优点，但其在获得性PAH患者中的可行性尚未确定。本研究的目的是：（1）证明CMR-RHC在常规诊断CMR扫描室接受PAH评估的患者中的可行性;（2）确定（i）手术持续时间和（ii）手术失败或技术困难的预测因素，如导丝的连续需要所确定的。方法对50例疑似或已知PH的患者进行CMR-RHC。记录单独手术组件的持续时间，包括将导管从股静脉传递到稳定楔形位置所需的时间（手术时间）和患者在CMR部门的总时间（部门时间）。使用逻辑回归评估手术失败/导丝使用与血流动力学/CMR指标之间的关联。使用斯皮尔曼相关系数评价手术时间与血流动力学/CMR测量值之间的关系。结果47例（94%）患者成功完成了完整的CMR-RHC研究。6例（12%）患者使用了CMR特定条件安全导丝。与导丝使用/手术失败相关的风险是平均肺动脉（PA）压较高（mPAP：OR = 1.125，p = 0.018），右心扩张（右心室（RV）收缩末期容积（RVESV）：OR = 1.028，p = 0.018）、RV肥大（OR = 1.050，p = 0.0067）和RV射血分数（EF）（OR = 0.914，p = 0.014）。导管和科室的平均时间分别为3.6（2.0-7.7）分钟和60.0（54.0-68.5）分钟。随着手术经验的增加，所有手术时间均显著缩短（p < 0.05）。导管插入时间也与PH严重程度（RV收缩压：rho = 0.46，p = 0.0013）和RV收缩末期容积增加（RVESV：rho = 0.41，p = 0.0043）、肥大（rho = 0.43，p = 0.0025）和功能障碍（RVEF：rho = - 0.32，p = 0.031）相关。结论本研究表明，使用标准技术的CMR-RHC可纳入PAH研究的常规临床实践。手术失败罕见，但在重度PAH患者中更有可能。手术时间在临床上是可接受的，并且随着PAH严重程度的恶化而增加。
Background Cardiovascular magnetic resonance imaging (CMR) is valuable for the investigation and management of pulmonary artery hypertension (PAH), but the direct measurement of pulmonary hemodynamics by right heart catheterization is still necessary. CMR-guided right heart catheterization (CMR-RHC) combines the benefits of CMR and invasive cardiac catheterization, but its feasibility in patients with acquired PAH has not been established. The aims of this study are to: (1) demonstrate the feasibility of CMR-RHC in patients being assessed for PAH in a conventional diagnostic CMR scanner room; (2) determine the predictors of (i) procedure duration, and (ii) procedural failure or technical difficulty as determined by the adjunctive need for a guidewire. Methods Fifty patients investigated for suspected or known PH underwent CMR-RHC. Durations of separate procedural components were recorded, including time taken to pass the catheter from the femoral vein to a stable wedge position (procedure time) and total time the patient spent in the CMR department (department time). Associations between procedural failure/guidewire usage and hemodynamic/CMR measures were assessed using logistic regression. Relationships between procedure times and hemodynamic/CMR measures were evaluated using Spearman's correlation coefficient. Results A full CMR-RHC study was successfully completed in 47 (94%) patients. CMR-conditional guidewires were used in 6 (12%) patients. Metrics associated with guidewire use/procedural failure were higher mean pulmonary artery (PA) pressures (mPAP: OR = 1.125, p = 0.018), right heart dilatation (right ventricular (RV) end-systolic volume (RVESV): OR = 1.028, p = 0.018), RV hypertrophy (OR = 1.050, p = 0.0067) and RV ejection fraction (EF) (OR = 0.914, p = 0.014). Median catheter and department times were 3.6 (2.0-7.7) minutes and 60.0 (54.0-68.5) minutes, respectively. All procedure times became significantly shorter with increasing procedural experience (p < 0.05). Catheterization time was also associated with PH severity (RV systolic pressure: rho = 0.46, p = 0.0013) and increasing RV end-systolic volume (RVESV: rho = 0.41, p = 0.0043), hypertrophy (rho = 0.43, p = 0.0025) and dysfunction (RVEF: rho = - 0.32, p = 0.031). Conclusions This study demonstrates that CMR-RHC using standard technology can be incorporated into routine clinical practice for the investigation of PAH. Procedural failure was rare but more likely in patients with severe PAH. Procedure time is clinically acceptable and increases with worsening PAH severity.