Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.
J Cardiovasc Comput Tomogr. 2011 Jan-Feb;5(1):44-9. doi: 10.1016/j.jcct.2010.10.005. Epub 2010 Oct 23.
Computed tomography coronary angiography (CTCA) provides an accurate noninvasive alternative to the invasive assessment of coronary artery disease. However, a specific limitation of CTCA is inability to assess hemodynamic data.
We hypothesized that CTCA-derived measurements of contrast within the superior vena cava (SVC) and inferior vena cava (IVC) would correlate to echocardiographic estimations of right atrial and right ventricular pressures.
Medical records of all patients who underwent both echocardiography and CTCA in our center were reviewed (n = 32). Standard CTCA was performed with a 64-detector CT using test-bolus method for image acquisition timing and iso-osmolar contrast injection through upper extremity vein. The length of the column of contrast reflux into the inferior vena cava (IVC) was correlated to echocardiographically determine tricuspid regurgitation jet velocity (TRV). SVC area change with contrast injection at the level of the bifurcation of the pulmonary artery was also correlated with IVC sniff response by echocardiogram.
The reflux column length was interpretable in 27 of 32 patients with a mean length of 10.1 ± 1.1 mm, and a significant bivariate correlation was observed between reflux column length and the tricuspid regurgitant jet velocity (r = 0.84; P < .0001). Mean SVC distensibility ratio was 0.63 ± 0.03; mean IVC sniff response ratio was 0.53 ± 0.03. SVC distensibility correlated to IVC sniff response with a Pearson r of 0.57 (P = .04).
Quantification of IVC and SVC contrast characteristics during CTCA provides a feasible and potentially accurate method of estimating right atrial and ventricular pressure.
计算机断层扫描冠状动脉造影（CTCA）为评估冠状动脉疾病提供了一种准确的非侵入性替代方法。然而，CTCA 的一个特定局限性是无法评估血液动力学数据。
我们假设 CTCA 测量上腔静脉（SVC）和下腔静脉（IVC）内的造影剂会与超声心动图估计右心房和右心室压力相关。
我们回顾了在我们中心同时进行超声心动图和 CTCA 的所有患者的病历（n=32）。使用 64 排 CT 机进行标准 CTCA，采用测试团注法进行图像采集时间定位，通过上肢静脉注入等渗对比剂。将对比剂反流至下腔静脉（IVC）的柱长与超声心动图测定三尖瓣反流射流速度（TRV）相关。在肺动脉分叉水平测量 SVC 对比剂注射时的面积变化，与超声心动图测量 IVC 抽吸反应相关。
27/32 例患者的反流柱长可解释，平均长度为 10.1±1.1mm，反流柱长与三尖瓣反流射流速度之间存在显著的双变量相关性（r=0.84；P<0.0001）。SVC 顺应性比值的平均值为 0.63±0.03；IVC 抽吸反应比值的平均值为 0.53±0.03。SVC 顺应性与 IVC 抽吸反应呈正相关，Pearson r 为 0.57（P=0.04）。
CTCA 期间 IVC 和 SVC 对比特征的定量提供了一种可行且潜在准确的估计右心房和心室压力的方法。
