Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress.
Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress.
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DOI：
10.1186/1532-429x-14-5
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发表时间：
2012-01-12
期刊：
影响因子：
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通讯作者：
Marcus JT
中科院分区：
文献类型：
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作者：
Mauritz GJ;Vonk-Noordegraaf A;Kind T;Surie S;Kloek JJ;Bresser P;Saouti N;Bosboom J;Westerhof N;Marcus JT
室间机械不同步是肺动脉高压的一个特征。我们研究了慢性血栓栓塞性肺动脉高压（CTEPH）肺动脉内膜切除术（PEA）后右心室（RV）壁应力在室间不同步恢复中的作用。在连续 13 例 CTEPH 患者中，在肺动脉内膜切除术之前和术后 6 个月，应用了心血管磁共振心肌标记。对于左心室 (LV) 和 RV 游离壁，计算周向缩短（应变）达到峰值的时间 (Tpeak)。 PEA 后 48 小时内通过右心导管插入术测量肺动脉压 (PAP)。然后通过拉普拉斯定律计算RV自由壁收缩壁应力。 PEA 后，Tpeak 应变的左到右游离壁延迟（L-R 延迟）从 97 ± 49 ms 降至 -4 ± 51 ms (P < 0.001)，与正常参考值 -35 ± 10 ms (P = 0.18) 没有差异。右心室壁应力从 15.2 ± 6.4 kPa 显着下降至 5.7 ± 3.4 kPa (P < 0.001)，与正常参考值 5.3 ± 1.39 kPa (P = 0.78) 没有差异。 Tpeak 中 L-R 延迟的减少与 RV 壁应力的减少 (r = 0.69, P = 0.007) 的相关性比收缩期 PAP 的减少 (r = 0.53, P = 0.07) 的相关性更强。 Tpeak 中 L-R 延迟的减少与 RV 半径的减少（r = 0.37，P = 0.21）或 RV 收缩期壁厚度的增加（r = 0.19，P = 0.53）的估计无关。对 CTEPH 进行 PEA 后，RV 和 LV 峰值应变重新同步。收缩期右心室壁应力的减少在这种重新同步中起着关键作用。
Interventricular mechanical dyssynchrony is a characteristic of pulmonary hypertension. We studied the role of right ventricular (RV) wall stress in the recovery of interventricular dyssynchrony, after pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH). In 13 consecutive patients with CTEPH, before and 6 months after pulmonary endarterectomy, cardiovascular magnetic resonance myocardial tagging was applied. For the left ventricular (LV) and RV free walls, the time to peak (Tpeak) of circumferential shortening (strain) was calculated. Pulmonary Artery Pressure (PAP) was measured by right heart catheterization within 48 hours of PEA. Then the RV free wall systolic wall stress was calculated by the Laplace law. After PEA, the left to right free wall delay (L-R delay) in Tpeak strain decreased from 97 ± 49 ms to -4 ± 51 ms (P < 0.001), which was not different from normal reference values of -35 ± 10 ms (P = 0.18). The RV wall stress decreased significantly from 15.2 ± 6.4 kPa to 5.7 ± 3.4 kPa (P < 0.001), which was not different from normal reference values of 5.3 ± 1.39 kPa (P = 0.78). The reduction of L-R delay in Tpeak was more strongly associated with the reduction in RV wall stress (r = 0.69,P = 0.007) than with the reduction in systolic PAP (r = 0.53, P = 0.07). The reduction of L-R delay in Tpeak was not associated with estimates of the reduction in RV radius (r = 0.37,P = 0.21) or increase in RV systolic wall thickness (r = 0.19,P = 0.53). After PEA for CTEPH, the RV and LV peak strains are resynchronized. The reduction in systolic RV wall stress plays a key role in this resynchronization.