经皮肺动脉瓣植入术减轻右心室压力和/或容量超负荷对运动时双心室反应的影响：一项运动负荷实时心脏磁共振研究。
Impact of reduction in right ventricular pressure and/or volume overload by percutaneous pulmonary valve implantation on biventricular response to exercise: an exercise stress real-time CMR study.
机构信息
Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London, UK.
出版信息
Eur Heart J. 2012 Oct;33(19):2434-41. doi: 10.1093/eurheartj/ehs200. Epub 2012 Jul 12.
AIMS
To assess the impact of relief of pulmonary stenosis (PS) and pulmonary regurgitation (PR) by percutaneous pulmonary valve implantation (PPVI) on biventricular function during exercise stress.
METHODS AND RESULTS
Seventeen patients, who underwent PPVI for PS or PR, were included. Magnetic resonance imaging was performed at rest and during supine exercise stress pre- and within 1-month post-PPVI, using a radial k - t SENSE real-time sequence. In patients with PS (n = 9), there was no reserve in right ventricular (RV) ejection fraction (EF) in response to exercise prior to PPVI (48.2 ± 12.1% at rest vs. 48.4 ± 14.8% during exercise, P = 0.87). Post-PPVI, reserve in RVEF in response to exercise was re-established (53.4 ± 15.0% at rest vs. 59.6 ± 17.3% during exercise, P = 0.003) with improvement in left ventricular stroke volume (LVSV) (45.4 ± 6.2 mL/m(2) at rest vs. 52.8 ± 8.8 mL/m(2) during exercise, P = 0.001). In patients with PR prior to PPVI (n = 8), LVSV during exercise increased (43.0 ± 8.5 vs. 54.3 ± 6.6 mL/m(2), P < 0.001) due to reduction in PR fraction during exercise (29.2 ± 5.2 vs. 13.6 ± 6.1%, P < 0.001). After PPVI, LVSV increased from rest to exercise (48.4 ± 8.8 vs. 57.2 ± 8.1 mL/m(2), P < 0.001) due to improved RVEF (45.5 ± 8.3 vs. 50.4 ± 6.9%, P = 0.001). There was a significantly higher increase in LVSV at exercise from pre- to post-PPVI in PS patients than in PR patients (ΔLVSV 8.2 ± 4.1 vs. Δ2.9 ± 4.1 mL/m(2), P = 0.01). The reduction in the RV outflow tract gradient correlated significantly with the improvement in LVSV during exercise (r = -0.73, P < 0.001).
CONCLUSION
Percutaneous pulmonary valve implantation in patients with PS leads to restoration of reserve in RVEF during exercise stress. In patients with PR, SV augmentation improves only mildly post-PPVI. Improvement in SV augmentation during exercise stress after PPVI is dependent mainly on afterload reduction.
目的
评估经皮肺动脉瓣植入术（PPVI）缓解肺动脉瓣狭窄（PS）和肺动脉瓣反流（PR）对运动负荷下双心室功能的影响。
方法和结果
共纳入 17 例因 PS 或 PR 而行 PPVI 的患者。在 PPVI 前和 1 个月内，使用径向 k - t SENSE 实时序列，在静息和仰卧位运动负荷下进行磁共振成像。在 PS 患者（n = 9）中，PPVI 前运动时右心室（RV）射血分数（EF）无储备（静息时 48.2 ± 12.1%，运动时 48.4 ± 14.8%，P = 0.87）。PPVI 后，RV 射血分数对运动的储备得到恢复（静息时 53.4 ± 15.0%，运动时 59.6 ± 17.3%，P = 0.003），左心室每搏量（LVSV）改善（静息时 45.4 ± 6.2 mL/m 2 ，运动时 52.8 ± 8.8 mL/m 2 ，P = 0.001）。在 PPVI 前有 PR 的患者（n = 8），运动时 LVSV 增加（43.0 ± 8.5 vs. 54.3 ± 6.6 mL/m 2 ，P < 0.001），这是由于运动时 PR 分数减少（29.2 ± 5.2 vs. 13.6 ± 6.1%，P < 0.001）。PPVI 后，LVSV 从静息增加到运动（48.4 ± 8.8 vs. 57.2 ± 8.1 mL/m 2 ，P < 0.001），这是由于 RV 射血分数改善（45.5 ± 8.3 vs. 50.4 ± 6.9%，P = 0.001）。PS 患者 PPVI 后与前相比，运动时 LVSV 增加明显大于 PR 患者（ΔLVSV 8.2 ± 4.1 vs. Δ2.9 ± 4.1 mL/m 2 ，P = 0.01）。RV 流出道梯度降低与运动时 LVSV 改善显著相关（r = -0.73，P < 0.001）。
结论
PS 患者行经皮肺动脉瓣植入术可恢复运动负荷下 RV 射血分数的储备。PR 患者 PPVI 后 SV 增加仅轻度改善。PPVI 后运动时 SV 增加主要取决于后负荷降低。
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