计算机断层扫描肺动脉造影的心血管参数评估慢性血栓栓塞性肺动脉高压患者的肺血管阻力。
Cardiovascular parameters of computed tomographic pulmonary angiography to assess pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension.
机构信息
Department of Radiology, Chao Yang Hospital, Capital Medical University, Beijing 100020, China.
出版信息
Int J Cardiol. 2013 Apr 15;164(3):295-300. doi: 10.1016/j.ijcard.2011.07.019. Epub 2011 Aug 5.
OBJECTIVES
The purpose is to identify the role of cardiovascular parameters of computed tomographic pulmonary angiography (CTPA) to assess pulmonary vascular resistance (PVR) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
BACKGROUND
The assessment of PVR is of great importance in the management of patients with CTEPH. The role of CPTA in assessment of PVR of CTEPH remains to be explored.
METHODS
Clinical and radiological data of 90 patients (55 men, age 17-84 years) with CTEPH were retrospectively reviewed in this study. All patients received CTPA before right-heart catheterization. Cardiovascular parameters and Pulmonary Artery Obstruction Indices including Qanadli Index and Mastora Index were evaluated on CTPA. Hemodynamic PVR was calculated with the standard formula according to data from right-heart catheterization. The correlation of cardiovascular parameters of CTPA and PVR was analyzed.
RESULTS
In Cardiovascular parameters, neither Qanadli Index(r=0.134, p=0.208) nor Mastora Index (r=0.149, p=0.90) did correlate with PVR. Cobb angle(r=0.613, p=0.000), the ratio of right to left ventricular area(r=0.422, p=0.000)and the ratio of right to left ventricular transverse diameter (r=0.410, p=0.000) respectively correlated with PVR. By receiver operating characteristic curve analysis, a Cobb angle cutoff value of 67.55° had a sensitivity of 72.5% and a specificity of 84.0% to determine PVR ≥1000 (dyn.sec/cm(5)) and its Area Under Curve is (0.800 ± 0.048). By stepwise linear regression analysis, Cobb angle was only one variable (R=0.601) shown to be independently associated with PVR, leading to the following equation: PVR=25.796 × Cobb angle-585.935(F=37.929, p=0.000).
CONCLUSION
The analysis of CTPA-derived cardiovascular parameters, especially the Cobb angle, is a reliable tool for estimating PVR in patients with CTEPH, but Pulmonary Artery Obstruction Indices do not correlate with PVR.
目的
旨在确定计算机断层肺动脉造影（CTPA）的心血管参数在慢性血栓栓塞性肺动脉高压（CTEPH）患者中评估肺血管阻力（PVR）的作用。
背景
评估 PVR 在 CTEPH 患者的管理中非常重要。CPTA 在评估 CTEPH 患者的 PVR 中的作用仍有待探索。
方法
本研究回顾性分析了 90 例（55 名男性，年龄 17-84 岁）CTEPH 患者的临床和放射学数据。所有患者均在右心导管检查前接受 CTPA。在 CTPA 上评估心血管参数和肺动脉阻塞指数，包括 Qanadli 指数和 Mastora 指数。根据右心导管检查数据，用标准公式计算血流动力学 PVR。分析 CTPA 心血管参数与 PVR 的相关性。
结果
在心血管参数方面，Qanadli 指数（r=0.134，p=0.208）和 Mastora 指数（r=0.149，p=0.90）均与 PVR 无相关性。Cobb 角（r=0.613，p=0.000）、右心室与左心室面积比（r=0.422，p=0.000）和右心室与左心室横径比（r=0.410，p=0.000）分别与 PVR 相关。通过受试者工作特征曲线分析，Cobb 角截断值为 67.55°时，其对 PVR≥1000（dyn.sec/cm（5））的灵敏度为 72.5%，特异性为 84.0%，其曲线下面积为（0.800±0.048）。通过逐步线性回归分析，Cobb 角是唯一与 PVR 独立相关的变量（R=0.601），得出以下方程：PVR=25.796×Cobb 角-585.935（F=37.929，p=0.000）。
结论
分析 CTPA 衍生的心血管参数，尤其是 Cobb 角，是一种可靠的工具，可用于估计 CTEPH 患者的 PVR，但肺动脉阻塞指数与 PVR 不相关。
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