Rolf Andreas, Rixe Johannes, Kim Won K, Guth Stefan, Körlings Nils, Möllmann Helge, Nef Holger M, Liebetrau Christoph, Krombach Gabriele, Kramm Thorsten, Mayer Eckhard, Hamm Christian W
Department of Cardiology, Kerckhoff Heart and Lung Centre, Benekestrasse 2-8, 61231, Bad Nauheim, Germany,
Int J Cardiovasc Imaging. 2015 Mar;31(3):613-9. doi: 10.1007/s10554-014-0580-z. Epub 2014 Dec 18.
Phase-contrast magnetic resonance imaging (PC-MRI) offers a range of surrogate markers to quantify the hemodynamic changes associated with chronic thromboembolic pulmonary hypertension (CTEPH). Our aim was to noninvasively monitor effects of pulmonary vascular remodeling before and after endarterectomy (PEA) in patients with CTEPH by using PC-MRI. Fifty-seven consecutive patients (mean age 56.7 ± 16, 28 female) underwent PC-MRI before and after PEA as part of their peri-operative routine workup. Pulmonary artery (PA) maximum flow velocity (maxV), acceleration time/ejection time (AT/ET), distensibility [(PA maximum area - PA minimum area)/PA minimum area], mid-systolic flow deceleration (notch), and the timing of deceleration (notch ratio) were recorded. Mean PA pressure was obtained from standard right heart catheter procedures. maxV and AT/ET were decreased before PEA and significantly improved afterwards (60.8 ± 16 vs. 73.8 ± 19 cm/s, p = 0.007; 0.32 ± 0.06 vs. 0.36 ± 0.09, p = 0.0015). Surprisingly, distensibility did not change significantly (30 ± 19 vs. 26 ± 12%, p = 0.11). Forty-five patients (78%) had a systolic notch before PEA that persisted in only 10 (18%; p = 0.00001). Among patients with a persisting notch, the notch ratio did not significantly increase (1.3 ± 0.2 vs. 1.6 ± 1.5, p = 0.32). Our data show early PA reverse remodeling after PEA. Flow velocities increase while PA flow wave reflections represented by mid-systolic flow deceleration are abolished. In some patients a mid-systolic notch persists, suggesting increased downstream resistance as a consequence of small vessel arteriopathy.
相位对比磁共振成像（PC-MRI）提供了一系列替代标志物，以量化与慢性血栓栓塞性肺动脉高压（CTEPH）相关的血流动力学变化。我们的目的是通过使用PC-MRI对CTEPH患者在肺动脉内膜剥脱术（PEA）前后的肺血管重塑效果进行无创监测。57例连续患者（平均年龄56.7±16岁，女性28例）在PEA前后接受了PC-MRI检查，作为其围手术期常规检查的一部分。记录肺动脉（PA）最大流速（maxV）、加速时间/射血时间（AT/ET）、扩张性[（PA最大面积 - PA最小面积）/PA最小面积]、收缩中期血流减速（切迹）以及减速时间（切迹比率）。平均PA压力通过标准右心导管检查获得。maxV和AT/ET在PEA前降低，术后显著改善（60.8±16 vs. 73.8±19 cm/s，p = 0.007；0.32±0.06 vs. 0.36±0.09，p = 0.0015）。令人惊讶的是，扩张性没有显著变化（30±19 vs. 26±12%，p = 0.11）。45例患者（78%）在PEA前有收缩期切迹，仅10例（18%）术后仍持续存在（p = 0.00001）。在有持续切迹的患者中，切迹比率没有显著增加（1.3±0.2 vs. 1.6±1.5，p = 0.32）。我们的数据显示PEA后早期PA逆向重塑。流速增加，而以收缩中期血流减速为代表的PA血流波反射消失。在一些患者中，收缩中期切迹持续存在，提示小血管动脉病变导致下游阻力增加。
