Jardim C, Rochitte C E, Humbert M, Rubenfeld G, Jasinowodolinski D, Carvalho C R R, Souza R
Pulmonary Division, Pulmonary Hypertension Unit, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
Eur Respir J. 2007 Mar;29(3):476-81. doi: 10.1183/09031936.00016806. Epub 2006 Nov 29.
Pulmonary arterial hypertension (PAH) is a disease of the small vessels in which there is a substantial increase in pulmonary vascular resistance leading to right ventricle failure and death. Invasive haemodynamic evaluation is mandatory not only for diagnosis confirmation but also to address prognosis and eligibility for the use of calcium-channel blockers through an acute vasodilator challenge. Noninvasive surrogate response markers to the acute vasodilator test have been sought. In the present study, the relationship between pulmonary artery distensibility, assessed using magnetic resonance imaging (MRI), and response to acute vasodilator tests was investigated. In total, 19 patients diagnosed with idiopathic PAH without any specific treatment were evaluated. Within a 48-h window after pulmonary artery catheterisation, patients underwent cardiac MRI. Cardiac index, calculated after the determination (invasively and noninvasively) of cardiac output, showed excellent correlation, as did right atrial pressure and right ventricle ejection fraction. Pulmonary artery distensibility was significantly higher in responders. A receiver operating characteristic curve analysis has shown that 10% distensibility was able to differentiate responders from nonresponders with 100% sensitivity and 56% specificity. The present findings suggest that magnetic resonance imaging and pulmonary artery distensibility may be useful noninvasive tools for the evaluation of patients with pulmonary hypertension.
肺动脉高压（PAH）是一种小血管疾病，其肺血管阻力大幅增加，导致右心室衰竭和死亡。有创血流动力学评估不仅对于确诊至关重要，而且对于判断预后以及通过急性血管扩张剂激发试验确定是否适合使用钙通道阻滞剂也必不可少。人们一直在寻找急性血管扩张剂试验的无创替代反应标志物。在本研究中，研究了使用磁共振成像（MRI）评估的肺动脉可扩张性与急性血管扩张剂试验反应之间的关系。总共对19例未经任何特殊治疗的特发性PAH患者进行了评估。在肺动脉导管插入术后48小时内，患者接受了心脏MRI检查。在心输出量（通过有创和无创方法测定）确定后计算得出的心脏指数显示出极佳的相关性，右心房压力和右心室射血分数也是如此。反应者的肺动脉可扩张性明显更高。受试者工作特征曲线分析表明，10%的可扩张性能够以100%的敏感性和56%的特异性区分反应者和无反应者。目前的研究结果表明，磁共振成像和肺动脉可扩张性可能是评估肺动脉高压患者的有用无创工具。
