Prediction and assessment of the time-varying effective pulmonary vein area via cardiac MRI and Doppler echocardiography
Prediction and assessment of the time-varying effective pulmonary vein area via cardiac MRI and Doppler echocardiography
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DOI：
10.1152/ajpheart.00713.2004
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发表时间：
2005-01-01
影响因子：
4.8
通讯作者：
Kovács, SJ
中科院分区：
文献类型：
--
作者：
Bowman, AW;Kovács, SJ
使用多普勒超声心动图准确估计左心房（LA）容积仍然具有挑战性。Marino等人（Marino P，Prioli AM，Destro G，LoSchiavo I，Golia G，and Zardini P. Am Heart J 127：886-898，1994）使用血管造影术进行验证，通过对多普勒二尖瓣和肺静脉血流的速度-时间积分进行积分，假设二尖瓣和肺静脉面积恒定，确定了整个心动周期的LA体积。然而，这种LA体积测定方法从未与心脏MRI的三维LA体积数据进行过比较，心脏MRI是心腔体积测量的金标准。以前，我们确定有效二尖瓣面积不是恒定的，而是作为时间的函数而变化。因此，我们试图确定有效肺静脉面积（EPVA）是否也可能随时间变化，并评估了Marino估计左心房容积的方法。我们对10名正常受试者进行了心脏MRI和经胸多普勒超声心动图成像。通过MRI测量LA和左心室（LV）容积，通过多普勒超声心动图测量二尖瓣和肺静脉血流，并通过心电图同步时间依赖性。使用Marino方法估计的LA体积与MRI测量值进行比较。观察到差异，超声心动图和MRI方法之间的差异被用来预测EPVA作为时间的函数。EPVA也直接从短轴MRI图像测量，并被发现是随时间变化的预测值一致。我们的结论是，由于EPVA和LA容量时间依赖性是同相的，所以收缩期的LA充盈和舒张期的LV充盈都是易化的。目前正在对处于特定病理生理状态的受试者进行应用。
Accurately estimating left atrial ( LA) volume with Doppler echocardiography remains challenging. Using angiography for validation, Marino et al. (Marino P, Prioli AM, Destro G, LoSchiavo I, Golia G, and Zardini P. Am Heart J 127: 886-898, 1994) determined LA volume throughout the cardiac cycle by integrating the velocity-time integrals of Doppler transmitral and pulmonary venous flow, assuming constant mitral valve and pulmonary vein areas. However, this LA volume determination method has never been compared with three-dimensional LA volume data from cardiac MRI, the gold standard for cardiac chamber volume measurement. Previously, we determined that the effective mitral valve area is not constant but varies as a function of time. Therefore, we sought to determine whether the effective pulmonary vein area (EPVA) might be time varying as well and also assessed Marino's method for estimating LA volume. We imaged 10 normal subjects using cardiac MRI and concomitant transthoracic Doppler echocardiography. LA and left ventricular (LV) volumes were measured by MRI, transmitral and pulmonary vein flows were measured by Doppler echocardiography, and time dependence was synchronized via the electrocardiogram. LA volume, estimated using Marino's method, was compared with the MRI measurements. Differences were observed, and the discrepancy between the echocardiographic and MRI methods was used to predict EPVA as a function of time. EPVA was also directly measured from short-axis MRI images and was found to be time varying in concordance with predicted values. We conclude that because EPVA and LA volume time dependence are in phase, LA filling in systole and LV filling in diastole are both facilitated. Application to subjects in select pathophysiological states is in progress.