肺动脉高压的心肌延迟增强：肺血液动力学、右心室功能和重构。
Myocardial delayed enhancement in pulmonary hypertension: pulmonary hemodynamics, right ventricular function, and remodeling.
机构信息
Department of Radiology, Johns Hopkins University, 600 N Wolfe St., Nelson Basement, MRI 143, Baltimore, MD 21287, USA.
出版信息
AJR Am J Roentgenol. 2011 Jan;196(1):87-94. doi: 10.2214/ajr.09.4114.
OBJECTIVE
The purpose of this study was to assess predictors of MRI-identified septal delayed enhancement mass at the right ventricular (RV) insertion sites in relation to RV remodeling, altered regional mechanics, and pulmonary hemodynamics in patients with suspected pulmonary hypertension (PH).
SUBJECTS AND METHODS
Thirty-eight patients with suspected PH were evaluated with right heart catheterization and cardiac MRI. Ten age- and sex-matched healthy volunteers acted as controls for MRI comparison. Septal delayed enhancement mass was quantified at the RV insertions. Systolic septal eccentricity index, global RV function, and remodeling indexes were quantified with cine images. Peak systolic circumferential and longitudinal strain at the sites corresponding to delayed enhancement were measured with conventional tagging and fast strain-encoded MRI acquisition, respectively.
RESULTS
PH was diagnosed in 32 patients. Delayed enhancement was found in 31 of 32 patients with PH and in one of six patients in whom PH was suspected but proved absent (p = 0.001). No delayed enhancement was found in controls. Delayed enhancement mass correlated with pulmonary hemodynamics, reduced RV function, increased RV remodeling indexes, and reduced eccentricity index. Multiple linear regression analysis showed RV mass index was an independent predictor of total delayed enhancement mass (p = 0.017). Regional analysis showed delayed enhancement mass was associated with reduced longitudinal strain at the basal anterior septal insertion (r = 0.6, p < 0.01). Regression analysis showed that basal longitudinal strain remained an independent predictor of delayed enhancement mass at the basal anterior septal insertion (p = 0.02).
CONCLUSION
In PH, total delayed enhancement burden at the RV septal insertions is predicted by RV remodeling in response to increased afterload. Local fibrosis mass at the anterior septal insertion is associated with reduced regional longitudinal contractility at the base.
目的
本研究旨在评估右心室（RV）插入部位 MRI 识别的间隔延迟强化质量与 RV 重构、区域性力学改变和肺动脉高压（PH）患者肺血液动力学之间的关系。
受试者和方法
对 38 例疑似 PH 的患者进行右心导管检查和心脏 MRI 检查。10 名年龄和性别匹配的健康志愿者作为 MRI 比较的对照组。定量 RV 插入处的间隔延迟强化质量。用电影图像定量测量收缩期间隔偏心指数、整体 RV 功能和重构指数。用常规标记和快速应变编码 MRI 采集分别测量相应延迟强化部位的峰值收缩周向和纵向应变。
结果
诊断为 PH 的 32 例患者中，31 例发现延迟强化，而 PH 可疑但证实不存在的 6 例患者中仅 1 例发现延迟强化（p = 0.001）。对照组未发现延迟强化。延迟强化质量与肺血液动力学、RV 功能降低、RV 重构指数增加和偏心指数降低相关。多元线性回归分析显示 RV 质量指数是总延迟强化质量的独立预测因子（p = 0.017）。局部分析显示，延迟强化质量与基底前间隔插入部的纵向应变减少有关（r = 0.6，p < 0.01）。回归分析显示，基底纵向应变仍然是基底前间隔插入部延迟强化质量的独立预测因子（p = 0.02）。
结论
在 PH 中，RV 间隔插入部位的总延迟强化负荷是由 RV 重构对后负荷增加的反应所预测的。前间隔插入部的局部纤维化质量与基底节段的区域性纵向收缩力降低有关。
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