Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
JACC Cardiovasc Imaging. 2009 Nov;2(11):1271-81. doi: 10.1016/j.jcmg.2009.09.007.
This study sought to develop and validate a method for the integrated analysis of systolic and diastolic ventricular function.
An integrated approach to assess ventricular pump function, myocontractility (end-systolic pressure-volume relationship [ESPVR]), and diastolic compliance (end-diastolic pressure-volume relation [EDPVR]) is of high clinical value. Cardiac magnetic resonance (CMR) is well established for measuring global pump function, and catheterization-combined CMR was previously shown to accurately measure ESPVR, but not yet the EDPVR.
In 8 pigs, the CMR technique was compared with conductance catheter methods (gold standard) for measuring the EDPVR in the left and right ventricle. Measurements were performed at rest and during dobutamine administration. For CMR, the ESPVR was estimated with a single-beat approach by synchronizing invasive ventricular pressures with cine CMR-derived ventricular volumes. The EDPVR was determined during pre-load reduction from additional volume data that were obtained from real-time velocity-encoded CMR pulmonary/aortic blood flow measurements. Pre-load reduction was achieved by transient balloon occlusion of the inferior vena cava. The stiffness coefficient beta was calculated by an exponential fit from the EDPVR. After validation in the animal experiments, the EDPVR was assessed in a pilot study of 3 patients with a single ventricle using identical CMR and conductance catheter techniques.
Bland-Altman tests showed good agreement between conductance catheter-derived and CMR-derived EDPVR. In both ventricles of the pigs, dobutamine enhanced myocontractility (p < 0.01), increased stroke volume (p < 0.01), and improved diastolic function. The latter was evidenced by shorter early relaxation (p < 0.05), a downward shift of the EDPVR, and a decreased stiffness coefficient beta (p < 0.05). In contrast, in the patients, early relaxation was inconspicuous but the EDPVR shifted left-upward and the stiffness constant remained unchanged. The observed changes in diastolic function were not significantly different when measured with conductance catheter and CMR.
This novel CMR method provides differential information about diastolic function in conjunction with parameters of systolic contractility and global pump function.
本研究旨在开发和验证一种综合分析收缩和舒张心室功能的方法。
评估心室泵功能、心肌收缩力（收缩末期压力-容积关系 [ESPVR]）和舒张顺应性（舒张末期压力-容积关系 [EDPVR]）的综合方法具有重要的临床价值。心脏磁共振（CMR）广泛应用于测量整体泵功能，先前的导管联合 CMR 已被证明可以准确测量 ESPVR，但尚未测量 EDPVR。
在 8 头猪中，将 CMR 技术与导管法（金标准）进行比较，以测量左、右心室的 EDPVR。在休息和多巴酚丁胺给药期间进行测量。对于 CMR，通过同步心内压力与电影 CMR 衍生的心室容积，使用单次搏动方法估计 ESPVR。通过从实时速度编码 CMR 肺动脉/主动脉血流测量中获得的附加容积数据，在从下腔静脉短暂球囊闭塞实现前负荷降低期间确定 EDPVR。通过指数拟合从 EDPVR 计算僵硬系数β。在动物实验验证后，使用相同的 CMR 和导管技术对 3 例单心室患者进行了 EDPVR 初步研究。
Bland-Altman 检验显示导管衍生和 CMR 衍生的 EDPVR 之间具有良好的一致性。在猪的两个心室中，多巴酚丁胺增强了心肌收缩力（p < 0.01），增加了每搏量（p < 0.01），并改善了舒张功能。后者表现为早期松弛时间缩短（p < 0.05），EDPVR 下移，僵硬系数β降低（p < 0.05）。相反，在患者中，早期松弛不明显，但 EDPVR 向左上方移位，僵硬常数保持不变。使用导管和 CMR 测量时，舒张功能的观察到的变化没有显著差异。
这种新的 CMR 方法提供了关于舒张功能的差异化信息，同时还提供了收缩期收缩力和整体泵功能的参数。
