PET Imaging May Provide a Novel Biomarker and Understanding of Right Ventricular Dysfunction in Patients With Idiopathic Pulmonary Arterial Hypertension
PET Imaging May Provide a Novel Biomarker and Understanding of Right Ventricular Dysfunction in Patients With Idiopathic Pulmonary Arterial Hypertension
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DOI：
10.1161/circimaging.110.963207
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发表时间：
2011-11-01
影响因子：
7.5
通讯作者：
Johnson, Lynne L.
中科院分区：
文献类型：
--
作者：
Bokhari, Sabahat;Raina, Amresh;Johnson, Lynne L.
背景-肺动脉高压（PAH）的临床病程是可变的，关于右心室（RV）功能障碍的决定因素和进展的信息有限。目的是开发PET代谢成像的RV作为一种非侵入性的工具，在PAH.Methods和结果，我们进行了PET扫描16例特发性PAH（年龄41 +/- 14岁，82%的妇女）使用13 N-NH3灌注成像和（18）F-氟脱氧葡萄糖代谢成像。将心肌分为6个感兴趣区域（3个左心室[LV]，3个RV），并生成时间-活动曲线。采用二室模型计算心肌血流量（MBF），Patlak分析计算心肌葡萄糖摄取率（MGU）。所有患者均接受了心导管插入术、心脏MRI和心肺运动试验及气体交换。MBF、MGU、RV/LV MGU比值与临床参数相关。肺动脉（PA）压为79 +/- 19/30 +/- 8 mm Hg（平均48 +/- 10 mm Hg）。左心室的MBF为0.84 +/- 0.33 mL/g/min，右心室为0.45 +/- 0.14 mL/g/min。LV的平均MGU为136 +/- 72 nmol/g/min，RV为96 +/- 69 nmol/g/min。RV/LV MGU比值与PA收缩压（r=0.75，P=0.0085）和平均压（r=0.87，P=0.001）显著相关，与最大耗氧量（r=-0.59，P=0.05）轻微相关。RV游离壁MGU与PA平均压力也有良好的相关性（r=0.66，P=0.03）。结论：13 N-NH（3）和18 F-FDG PET扫描是定量特发性PAH患者RV血流和代谢的可行方法。(Circ血管造影。2011;4：641-647）。
Background-The clinical course in pulmonary arterial hypertension (PAH) is variable, and there is limited information on the determinants and progression of right ventricular (RV) dysfunction. The objective is to develop PET metabolic imaging of the RV as a noninvasive tool in patients with PAH.Methods and Results-We performed PET scanning in 16 patients with idiopathic PAH (age, 41 +/- 14 years, 82% women) using 13N-NH3 for perfusion imaging and (18)F-fluorodeoxyglucose for metabolic imaging. The myocardium was divided into 6 regions of interest (3 left ventricular [LV], 3 RV), and time-activity curves were generated. A 2-compartment model was used to calculate myocardial blood flow (MBF), and Patlak analysis was used to calculate the rate of myocardial glucose uptake (MGU). All patients underwent cardiac catheterization, cardiac MRI, and cardiopulmonary exercise testing with gas exchange. MBF, MGU, and the ratio of RV/LV MGU were correlated to clinical parameters. Pulmonary artery (PA) pressure was 79 +/- 19/30 +/- 8 mm Hg (mean, 48 +/- 10 mm Hg). MBF was 0.84 +/- 0.33 mL/g per minute for the LV and 0.45 +/- 0.14 mL/g per minute for the RV. Mean MGU was 136 +/- 72 nmol/g per minute for the LV and 96 +/- 69 nmol/g per minute for the RV. The ratio of RV/LV MGU correlated significantly with PA systolic (r=0.75, P=0.0085) and mean (r=0.87, P=0.001) pressure and marginally with maximum oxygen consumption (r=-0.59, P=0.05). RV free wall MGU also correlated well with mean PA pressure (r=0.66, P=0.03).Conclusions-PET scanning with (13)N-NH(3) and (18)F-fluorodeoxyglucose is a feasible modality for quantifying RV blood flow and metabolism in patients with idiopathic PAH. (Circ Cardiovasc Imaging. 2011;4:641-647.)