Effects of pulmonary endarterectomy on pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension, evaluated by interventricular septum curvature
Effects of pulmonary endarterectomy on pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension, evaluated by interventricular septum curvature
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DOI：
10.1177/2045894019897502
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发表时间：
2020-01-01
影响因子：
2.6
通讯作者：
Tatsumi, Koichiro
中科院分区：
文献类型：
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作者：
Saito, Takahiko;Kasai, Hajime;Tatsumi, Koichiro
据报道，在心电图门控320层多探测器计算机断层扫描图像中测量的室间隔曲率是有用的，并且比右心导管插入术侵入性更小，因为它可以提供慢性血栓栓塞性肺动脉高压患者肺动脉压的线索。虽然肺动脉内膜切除术是慢性血栓栓塞性肺动脉高压的有效治疗方法，但尚未对接受肺动脉内膜切除术的患者的室间隔曲率进行评估。我们评估了心电图门控320层多层螺旋CT室间隔弯曲是否可以预测慢性血栓栓塞性肺动脉高压患者的肺血流动力学，即使在肺动脉内膜切除术后。我们研究了40例慢性血栓栓塞性肺动脉高压患者（60.5 ± 9.7岁; 30例女性），这些患者于2010年12月至2018年7月在千叶大学医院接受了肺动脉内膜切除术。为了测量室间隔曲率，我们从心电图门控的320层多探测器计算机断层扫描的4D图像中制备了左心室短轴断层图像。计算收缩期和舒张期的室间隔半径和室间隔曲率。我们比较了肺动脉内膜切除术前后室间隔弯曲度和右心导管测量的肺血流动力学。肺动脉内膜剥脱术后，室间隔曲率与平均肺动脉压、收缩期肺动脉压和肺血管阻力的相关性消失，尽管室间隔曲率与肺动脉内膜剥脱术前的这些肺血流动力学参数相关。收缩期室间隔曲率的变化与平均肺动脉压、收缩期肺动脉压和肺血管阻力的变化有显著相关性。舒张期室间隔曲率与术前肺血流动力学也有显著相关性，但与术后肺血流动力学无相关性。肺动脉内膜剥脱术后室间隔弯曲度的变化可用于评价肺动脉内膜剥脱术的疗效，但与肺血流动力学无明显相关性。此外，我们的研究结果证实，室间隔曲率肺动脉内膜切除术前可以用来评估疾病的严重程度。
The interventricular septum curvature, measured in images of electrocardiogram-gated 320-slice multidetector computed tomography, is reportedly useful and less invasive than right heart catheterization, as it could provide clues regarding pulmonary arterial pressure in patients with chronic thromboembolic pulmonary hypertension. Although pulmonary endarterectomy is an efficient treatment for chronic thromboembolic pulmonary hypertension, the interventricular septum curvature in patients who have received pulmonary endarterectomy has not been evaluated. We evaluated whether the interventricular septum curvature on electrocardiogram-gated 320-slice multidetector computed tomography can predict pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension even after pulmonary endarterectomy. We studied 40 patients with chronic thromboembolic pulmonary hypertension (60.5 +/- 9.7 years; 30 females), who underwent pulmonary endarterectomy at Chiba University Hospital between December 2010 and July 2018. To measure the interventricular septum curvature, we prepared left ventricular short-axis tomographic images from 4D images of electrocardiogram-gated 320-slice multidetector computed tomography. We calculated the radius of interventricular septum and determined the interventricular septum curvature in both the systolic and diastolic phases. We compared the interventricular septum curvature with pulmonary hemodynamics measured by right heart catheterization before and after pulmonary endarterectomy. After pulmonary endarterectomy, the correlations of the interventricular septum curvature with mean pulmonary arterial pressure, systolic pulmonary arterial pressure, and pulmonary vascular resistance disappeared, although the interventricular septum curvature was correlated with these pulmonary hemodynamic parameters before pulmonary endarterectomy. Changes in systolic interventricular septum curvature revealed significant correlations with changes in mean pulmonary arterial pressure, systolic pulmonary arterial pressure and pulmonary vascular resistance. Diastolic interventricular septum curvature also showed significant correlations with preoperative pulmonary hemodynamics, but not with postoperative pulmonary hemodynamics. Changes in the interventricular septum curvature after pulmonary endarterectomy could estimate the efficacy of pulmonary endarterectomy, although the interventricular septum curvature after pulmonary endarterectomy showed no significant correlations with pulmonary hemodynamics. Additionally, our findings confirmed that the interventricular septum curvature before pulmonary endarterectomy could be used to evaluate the severity of disease.