Rutten Frans H, Vonken Evert J, Cramer Maarten J, Moons Karel G, Velthuis Birgitta B, Prakken Niek H, Lammers Jan W, Grobbee Diederick E, Mali Willem P, Hoes Arno W
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Am Heart J. 2008 Sep;156(3):506-12. doi: 10.1016/j.ahj.2008.04.021. Epub 2008 Jun 17.
Although cardiovascular magnetic resonance imaging (CMR) is well established, its diagnostic accuracy in identifying chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD) has not yet been quantified.
Participants were recruited from a cohort of 405 patients aged >or=65 years, with mild to moderate and stable COPD. In this population, 83 (20.5%) patients had a new diagnosis of CHF, all left-sided, established by an expert panel using all available diagnostic information, including echocardiography. In a nested case-control study design, 37 consecutive COPD patients with newly detected CHF (cases) and a random sample of 41 of the remaining COPD patients (controls) received additional CMR measurements. The value of CMR in diagnosing heart failure was quantified using univariable and multivariable logistic modeling in combination with area under the receiver operating characteristic curves (ROC-area).
Combination of CMR measurements of left ventricular ejection fraction, indexed left and right atrial volume, and left ventricular end-systolic dimensions provided high added diagnostic value beyond clinical items (ROC-area 0.91) for identifying CHF. Left-sided measurements of CMR and echocardiography correlated well, including ejection fraction. Right ventricular mass divided by right ventricular end-diastolic volume was higher in COPD patients with CHF than in those without concomitant CHF.
Easily assessable morphologic and volume-based CMR measurements have excellent capacities to identify previously unknown left-sided chronic heart failure in mild to moderate COPD patients. There seems to be an adaptive tendency to concentric right ventricular hypertrophy in COPD patients with left-sided CHF.
尽管心血管磁共振成像（CMR）已得到广泛应用，但其在慢性阻塞性肺疾病（COPD）患者中识别慢性心力衰竭（CHF）的诊断准确性尚未得到量化。
研究对象来自一组年龄≥65岁、患有轻至中度稳定COPD的405例患者。在这一人群中，83例（20.5%）患者新诊断为CHF，均为左心衰竭，由专家小组根据所有可用诊断信息（包括超声心动图）确诊。在一项巢式病例对照研究设计中，37例新检测出CHF的连续COPD患者（病例组）和其余41例COPD患者的随机样本（对照组）接受了额外的CMR测量。通过单变量和多变量逻辑模型结合受试者操作特征曲线下面积（ROC面积）来量化CMR在诊断心力衰竭中的价值。
左心室射血分数、左心房和右心房容积指数以及左心室收缩末期内径的CMR测量组合在识别CHF方面提供了高于临床指标的高附加诊断价值（ROC面积0.91）。CMR和超声心动图的左心测量结果相关性良好，包括射血分数。CHF的COPD患者右心室质量除以右心室舒张末期容积高于无CHF的患者。
易于评估的基于形态学和容积的CMR测量在识别轻至中度COPD患者中先前未知的左心慢性心力衰竭方面具有出色的能力。在患有左心CHF的COPD患者中似乎存在向同心性右心室肥厚的适应性趋势。
