Sanz Javier, Kariisa Mbabazi, Dellegrottaglie Santo, Prat-González Susanna, Garcia Mario J, Fuster Valentin, Rajagopalan Sanjay
Clinical Cardiac MR/CT Program, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York 10029, USA.
JACC Cardiovasc Imaging. 2009 Mar;2(3):286-95. doi: 10.1016/j.jcmg.2008.08.007.
This study sought to evaluate indexes of pulmonary artery (PA) stiffness in patients with pulmonary hypertension (PH) using same-day cardiac magnetic resonance (CMR) and right heart catheterization (RHC).
Pulmonary artery stiffness is increased in the presence of PH, although the relationship to PH severity has not been fully characterized.
Both CMR and RHC were performed on the same day in 94 patients with known or suspected PH. According to the RHC, patients were classified as having no PH (n = 13), exercise-induced PH (EIPH) only (n = 6), or PH at rest (n = 75). On CMR, phase-contrast images were obtained perpendicular to the pulmonary trunk. From CMR and RHC data, PA areas and indexes of stiffness (pulsatility, compliance, capacitance, distensibility, elastic modulus, and the pressure-independent stiffness index beta) were measured at rest.
All quantified indexes showed increased PA stiffness in patients with PH at rest in comparison with those with EIPH or no PH. Despite the absence of significant differences in baseline pressures, patients with EIPH had lower median compliance and capacitance than patients with no PH: 15 (interquartile range: 9 to 19.8) mm2/mm Hg versus 8.4 (interquartile range: 6 to 10.3) mm2/mm Hg, and 5.2 (interquartile range: 4.4 to 6.3) mm3/mm Hg versus 3.7 (interquartile range: 3.1 to 4.1) mm3/mm Hg, respectively (p < 0.05). The different measurements of PA stiffness, including stiffness index beta, showed significant correlations with PA pressures (r2 = 0.27 to 0.73). Reduced PA pulsatility (<40%) detected the presence of PH at rest with a sensitivity of 93% and a specificity of 63%.
Pulmonary artery stiffness increases early in the course of PH (even when PH is detectable only with exercise and before overt pressure elevations occur at rest). These observations suggest a potential contributory role of PA stiffness in the development and progression of PH.
本研究旨在使用同日心脏磁共振成像（CMR）和右心导管检查（RHC）评估肺动脉高压（PH）患者的肺动脉（PA）僵硬度指标。
尽管PA僵硬度与PH严重程度的关系尚未完全明确，但在PH存在时PA僵硬度会增加。
对94例已知或疑似PH的患者在同一天进行CMR和RHC检查。根据RHC检查结果，患者被分为无PH（n = 13）、仅运动性PH（EIPH，n = 6）或静息性PH（n = 75）。在CMR检查中，获取垂直于肺动脉主干的相位对比图像。根据CMR和RHC数据，在静息状态下测量PA面积和僵硬度指标（搏动性、顺应性、电容性、扩张性、弹性模量和压力无关性僵硬度指数β）。
与EIPH或无PH的患者相比，所有量化指标均显示静息性PH患者的PA僵硬度增加。尽管基线压力无显著差异，但EIPH患者的中位顺应性和电容性低于无PH的患者：分别为15（四分位间距：9至19.8）mm²/mm Hg对8.4（四分位间距：6至10.3）mm²/mm Hg，以及5.2（四分位间距：4.4至6.3）mm³/mm Hg对3.7（四分位间距：3.1至4.1）mm³/mm Hg（p < 0.05）。包括僵硬度指数β在内的不同PA僵硬度测量值与PA压力显著相关（r² = 0.27至0.73）。静息状态下PA搏动性降低（<40%）检测PH存在的敏感性为93%，特异性为63%。
在PH病程早期PA僵硬度即增加（即使PH仅在运动时可检测到且在静息时明显压力升高之前）。这些观察结果提示PA僵硬度在PH的发生和发展中可能起作用。
