Lu Qingqing, Li Dong, Yang Zhenwen, Han Yan, Cui Qian, Zhang Zhang, Yu Tielian
Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
Department of Cardiovascular Disease, Tianjin Medical University General Hospital, Tianjin 300052, China.
Zhongguo Fei Ai Za Zhi. 2015 Mar;18(3):167-71. doi: 10.3779/j.issn.1009-3419.2015.03.07.
Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation. Without treatment, PAH progresses rapidly to right ventricular (RV) failure and even death. Cardiac magnetic resonance imaging (CMRI) has been an accurate and reproducible tool to assessment of RV morphology and function, which are important factors in the prognosis of patients with PAH. The aim of this study is to investigate acute RV response to inhalation of aerosolized iloprost in patients with PAH using CMRI.
From March 2012 to March 2014, 48 patients with PAH underwent CMRI before and immediately after inhalation of iloprost with a single dose of 20 μg over 15 min-20 min. RV function parameters derived from CMRI images were analyzed before and after iloprost inhalation, including end-diastolic volume (EDV), end-diastolic area (EDA), end-systolic volume (ESV), end-systolic area (ESA), stroke volume (SV), ejection fraction (EF) and cardiac output (CO). Percentage of RV area change was also calculated [%RVAC=(EDA-ESA)/EDA×100%]. Wilcoxon's Sign Rank Test or Paired Samples t-Test was used to compare the differences of RV function parameters before and after inhalation.
After iloprost inhalation, all patients showed significant decrease in RV EDV and RV ESV (P=0.007, P<0.001 respectively). Whereas, there were significant increase in RV SV (P=0.014), RV EF (P=0.009) and %RVAC (P=0.006). RV CO had no significant difference before and after inhalation (P=0.851).
Inhalation of iloprost can immediately improve RV function in patients with PAH, and noninvasive evaluation of the acute response with CMRI is feasibility.
肺动脉高压（PAH）是一种进行性疾病，其特征为肺循环血压异常升高。若不进行治疗，PAH会迅速发展为右心室（RV）衰竭甚至死亡。心脏磁共振成像（CMRI）是评估RV形态和功能的一种准确且可重复的工具，而RV形态和功能是PAH患者预后的重要因素。本研究的目的是使用CMRI研究PAH患者吸入雾化伊洛前列素后右心室的急性反应。
2012年3月至2014年3月，48例PAH患者在吸入单剂量20μg伊洛前列素15至20分钟前后接受CMRI检查。分析CMRI图像得出的RV功能参数在伊洛前列素吸入前后的变化，包括舒张末期容积（EDV）、舒张末期面积（EDA）、收缩末期容积（ESV）、收缩末期面积（ESA）、每搏输出量（SV）、射血分数（EF）和心输出量（CO）。还计算了RV面积变化百分比[％RVAC =（EDA - ESA）/ EDA×100％]。采用Wilcoxon符号秩检验或配对样本t检验比较吸入前后RV功能参数的差异。
吸入伊洛前列素后，所有患者的RV EDV和RV ESV均显著降低（分别为P = 0.007，P <0.001）。然而，RV SV（P = 0.014）、RV EF（P = 0.009）和％RVAC（P = 0.006）显著增加。吸入前后RV CO无显著差异（P = 0.851）。
吸入伊洛前列素可立即改善PAH患者的RV功能，并且用CMRI对急性反应进行无创评估是可行的。
