Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom; INSIGNEO, Institute for In Silico Medicine, University of Sheffield, United Kingdom.
Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom.
JACC Cardiovasc Imaging. 2014 Dec;7(12):1209-17. doi: 10.1016/j.jcmg.2014.08.014. Epub 2014 Oct 31.
The goal of this study was to determine the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) features in patients with pulmonary hypertension.
The prognostic significance of LGE in the clinical assessment of patients with pulmonary hypertension remains uncertain.
Consecutive patients with suspected pulmonary hypertension seen at a specialist pulmonary hypertension referral center who underwent right heart catheterization and CMR with LGE imaging within 48 h were identified. Short-axis late-enhancement imaging was performed using a 3-dimensional gradient spoiled echocardiography sequence on a 1.5-T scanner. Three groups were identified: 1) no late enhancement of the myocardium; 2) late enhancement at the right ventricular insertion points (LGE-IP); and 3) late enhancement involving the right ventricular insertion points and the interventricular septum (LGE-S).
Of 194 patients, 162 had pulmonary hypertension. LGE was identified in 135 of 162 (83%) patients with pulmonary hypertension, and 47 (29%) of patients demonstrated LGE-S. Patients with LGE-S had significantly higher right ventricular end-diastolic volume index (p = 0.013) and lower mixed venous oxygen saturation (p = 0.045) than patients with LGE-IP alone. The presence of LGE-S (p = 0.022), but not LGE-IP alone, right ventricular end-systolic volume (p = 0.045), right ventricular ejection fraction (p = 0.034), mixed venous oxygen saturation (p = 0.021), mean right atrial pressure (0.027), and male sex (p = 0.002) predicted mortality. At multivariate analysis, male sex was the only significant predictor of mortality independent of covariate predictors (p = 0.027).
The presence of LGE at the right ventricular insertion points is suggestive of the presence of pulmonary hypertension. LGE may also be more extensive, involving the septum; however, after multivariable analysis including other factors associated with pulmonary hypertension, septal LGE was not associated with an increase in overall mortality.
本研究旨在确定晚期钆增强（LGE）心脏磁共振（CMR）特征在肺动脉高压患者中的预后价值。
LGE 在肺动脉高压患者临床评估中的预后意义尚不确定。
连续入选在肺动脉高压专科转诊中心就诊的疑似肺动脉高压患者，在右心导管检查和 48 小时内进行 LGE CMR。使用 1.5-T 扫描仪上的 3 维梯度扰相回波超声心动图序列进行短轴晚期增强成像。根据有无心肌晚期强化将患者分为 3 组：1）无心肌晚期强化；2）右心室插入点晚期强化（LGE-IP）；3）右心室插入点和室间隔均有晚期强化（LGE-S）。
在 194 例患者中，162 例有肺动脉高压。162 例肺动脉高压患者中，135 例（83%）有 LGE，47 例（29%）有 LGE-S。LGE-S 患者的右心室舒张末期容积指数显著高于仅 LGE-IP 患者（p=0.013），混合静脉血氧饱和度显著低于仅 LGE-IP 患者（p=0.045）。LGE-S 的存在（p=0.022），而不是仅 LGE-IP（p=0.045）、右心室收缩末期容积（p=0.034）、右心室射血分数（p=0.034）、混合静脉血氧饱和度（p=0.021）、平均右心房压（p=0.027）和男性（p=0.002）预测死亡率。多变量分析显示，男性是独立于肺动脉高压相关预测因素的唯一显著死亡率预测因素（p=0.027）。
右心室插入点的 LGE 提示存在肺动脉高压。LGE 可能更为广泛，累及间隔；然而，在包括与肺动脉高压相关的其他因素在内的多变量分析后，间隔 LGE 与总死亡率的增加无关。
