LGE Patterns in Pulmonary Hypertension Do Not Impact Overall Mortality
LGE Patterns in Pulmonary Hypertension Do Not Impact Overall Mortality
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DOI：
10.1016/j.jcmg.2014.08.014
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发表时间：
2014-12-01
影响因子：
14
通讯作者：
Kiely, David G.
中科院分区：
文献类型：
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作者：
Swift, Andrew J.;Rajaram, Smitha;Kiely, David G.
目的：本研究的目的是确定晚期钆增强（LGE）心脏磁共振（CMR）特征在肺动脉高压患者中的预后价值。背景LGE在肺动脉高压患者临床评估中的预后意义尚不明确。方法对在专科肺动脉高压转诊中心连续就诊的疑似肺动脉高压患者进行鉴定，这些患者在48小时内接受了右心导管和CMR伴LGE成像。在1.5 t扫描仪上使用三维梯度破坏超声心动图序列进行短轴后期增强成像。分为三组：1)心肌无迟发性增强；2)右心室插入点晚期增强（LGE-IP）；3)晚期强化累及右心室插入点和室间隔（LGE-S）。结果194例患者中，162例合并肺动脉高压。162例肺动脉高压患者中有135例（83%）存在LGE， 47例（29%）存在LGE- s。与单独使用LGE-IP的患者相比，合并LGE-S的患者右心室舒张末期容积指数（p = 0.013）显著升高，混合静脉氧饱和度（p = 0.045）显著降低。LGE-S的存在（p = 0.022）、右心室收缩末期容积（p = 0.045）、右心室射血分数（p = 0.034）、混合静脉氧饱和度（p = 0.021）、平均右心房压（0.027）和男性性别（p = 0.002）预测死亡率。在多变量分析中，男性是唯一独立于协变量预测因子的显著死亡率预测因子（p = 0.027）。结论右室插入点LGE提示肺动脉高压的存在。LGE也可能更广泛，累及鼻中隔；然而，在包括与肺动脉高压相关的其他因素的多变量分析后，室间隔LGE与总死亡率的增加无关。(C) 2014年由美国心脏病学会基金会发布。
OBJECTIVES The goal of this study was to determine the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) features in patients with pulmonary hypertension.BACKGROUND The prognostic significance of LGE in the clinical assessment of patients with pulmonary hypertension remains uncertain.METHODS Consecutive patients with suspected pulmonary hypertension seen at a specialist pulmonary hypertension referral center who underwent right heart catheterization and CMR with LGE imaging within 48 h were identified. Short-axis late-enhancement imaging was performed using a 3-dimensional gradient spoiled echocardiography sequence on a 1.5-T scanner. Three groups were identified: 1) no late enhancement of the myocardium; 2) Late enhancement at the right ventricular insertion points (LGE-IP); and 3) late enhancement involving the right ventricular insertion points and the interventricular septum (LGE-S).RESULTS Of 194 patients, 162 had pulmonary hypertension. LGE was identified in 135 of 162 (83%) patients with pulmonary hypertension, and 47 (29%) of patients demonstrated LGE-S. Patients with LGE-S had significantly higher right ventricular end-diastolic volume index (p = 0.013) and Lower mixed venous oxygen saturation (p = 0.045) than patients with LGE-IP alone. The presence of LGE-S (p = 0.022), but not LGE-IP alone, right ventricular end-systolic volume (p = 0.045), right ventricular ejection fraction (p = 0.034), mixed venous oxygen saturation (p = 0.021), mean right atrial pressure (0.027), and male sex (p = 0.002) predicted mortality. At multivariate analysis, male sex was the only significant predictor of mortality independent of covariate predictors (p = 0.027).CONCLUSIONS The presence of LGE at the right ventricular insertion points is suggestive of the presence of pulmonary hypertension. LGE may also be more extensive, involving the septum; however, after multivariable analysis including other factors associated with pulmonary hypertension, septal LGE was not associated with an increase in overall mortality. (C) 2014 by the American College of Cardiology Foundation.