Koskenvuo Juha W, Karra Henna, Lehtinen Jaakko, Niemi Pekka, Pärkkä Jussi, Knuuti Juhani, Hartiala Jaakko J
Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
Clin Physiol Funct Imaging. 2007 Nov;27(6):385-93. doi: 10.1111/j.1475-097X.2007.00764.x.
We evaluated a value of Qp/Qs (left-to-right shunt measurement) using volumetric cardiac magnetic resonance (CMR) cardiac output (CO) measurements. We defined intraobserver, interobserver variability and reproducibility of left and right ventricular parameters by CMR. Furthermore, we studied whether shortened acquisition time has an effect on the accuracy of left and right ventricular parameters both in healthy volunteers and in patients with cardiovascular disease.
Sixteen subjects were enrolled in this study. Group A (n = 8, five males) consisted of healthy volunteers with a mean age of 25.9 years (range 24-30). Group B (n = 8, four males) was heterogenic consisting of patients with left ventricular (LV) hypertrophy, hypertension or coronary artery disease with their mean age of 56.3 years (range 38-70).
The measured Qp/Qs as calculated from the right and LV CO was 0.87 +/- 0.13. Overall variability [as presented with the lowest coefficient of variation (CV)%- the highest CV % of intraobserver, interobserver variability or reproducibility] of LV parameters were for ejection fraction (EF) 1.5-2.8%, stroke volume (SV) 1.3-3.2%, CO 1.4-3.2%, end-diastolic volume 0.5-3.0%, end-systolic volume 1.8-6.2% and LV mass 1.1-2.6%. Corresponding values for right ventricular parameters were for EF 1.1-4.2%, SV 1.9-8.2%, CO 1.9-7.6%, end-diastolic volume 2.1-7.6%, end-systolic volume 2.8-10.2% and right ventricle mass 2.9-8.3%. There was no statistically significant difference between the results of different sequences.
The CMR allows accurate Qp/Qs observation but the absolute value is at slightly different level compared with reference methods. Both left and right ventricular parameters are highly reproducible and even small clinically relevant changes can be measured with CMR. The shortened acquisition does not affect significantly to the accuracy of CMR-derived parameters.
我们使用容积性心脏磁共振成像(CMR)测量的心输出量(CO)评估了Qp/Qs(左向右分流测量)的值。我们通过CMR定义了左、右心室参数的观察者内、观察者间变异性及可重复性。此外,我们研究了缩短采集时间是否会对健康志愿者和心血管疾病患者的左、右心室参数准确性产生影响。
本研究纳入了16名受试者。A组(n = 8,5名男性)由平均年龄为25.9岁(范围24 - 30岁)的健康志愿者组成。B组(n = 8,4名男性)为异质性组,由左心室(LV)肥厚、高血压或冠状动脉疾病患者组成,平均年龄为56.3岁(范围38 - 70岁)。
根据右心室和左心室CO计算得出的测量Qp/Qs为0.87±0.13。左心室参数的总体变异性[以最低变异系数(CV)% - 观察者内、观察者间变异性或可重复性的最高CV%表示],射血分数(EF)为1.5 - 2.8%,每搏输出量(SV)为1.3 - 3.2%,CO为1.4 - 3.2%,舒张末期容积为0.5 - 3.0%,收缩末期容积为1.8 - 6.2%,左心室质量为1.1 - 2.6%。右心室参数的相应值为EF 1.1 - 4.2%,SV 1.9 - 8.2%,CO 1.9 - 7.6%,舒张末期容积2.1 - 7.6%,收缩末期容积2.8 - 10.2%,右心室质量2.9 - 8.3%。不同序列的结果之间无统计学显著差异。
CMR可实现准确的Qp/Qs观察,但与参考方法相比,绝对值处于略有不同的水平。左、右心室参数均具有高度可重复性,甚至CMR能够测量临床上相关的微小变化。采集时间的缩短对CMR衍生参数的准确性无显著影响。