Corona-Villalobos Celia P, Kamel Ihab R, Rastegar Neda, Damico Rachel, Kolb Todd M, Boyce Danielle M, Sager Ala-Eddin S, Skrok Jan, Shehata Monda L, Vogel-Claussen Jens, Bluemke David A, Girgis Reda E, Mathai Stephen C, Hassoun Paul M, Zimmerman Stefan L
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Pulm Circ. 2015 Sep;5(3):527-37. doi: 10.1086/682229.
We tested the hypothesis that bidimensional measurements of right ventricular (RV) function obtained by cardiac magnetic resonance imaging (CMR) in patients with pulmonary arterial hypertension (PAH) are faster than volumetric measures and highly reproducible, with comparable ability to predict patient survival. CMR-derived tricuspid annular plane systolic excursion (TAPSE), RV fractional shortening (RVFS), RV fractional area change (RVFAC), standard functional and volumetric measures, and ventricular mass index (VMI) were compared with right heart catheterization data. CMR analysis time was recorded. Receiver operating characteristic curves, Kaplan-Meier, Cox proportional hazard (CPH), and Bland-Altman test were used for analysis. Forty-nine subjects with PAH and 18 control subjects were included. TAPSE, RVFS, RVFAC, RV ejection fraction, and VMI correlated significantly with pulmonary vascular resistance and mean pulmonary artery pressure (all P < 0.05). Patients were followed up for a mean (± standard deviation) of 2.5 ± 1.6 years. Kaplan-Meier curves showed that death was strongly associated with TAPSE <18 mm, RVFS <16.7%, and RVFAC <18.8%. In CPH models with TAPSE as dichotomized at 18 mm, TAPSE was significantly associated with risk of death in both unadjusted and adjusted models (hazard ratio, 4.8; 95% confidence interval, 2.0-11.3; P = 0.005 for TAPSE <18 mm). There was high intra- and interobserver agreement. Bidimensional measurements were faster (1.5 ± 0.3 min) than volumetric measures (25 ± 6 min). In conclusion, TAPSE, RVFS, and RVFAC measures are efficient measures of RV function by CMR that demonstrate significant correlation with invasive measures of PAH severity. In patients with PAH, TAPSE, RVFS, and RVFAC have high intra- and interobserver reproducibility and are more rapidly obtained than volumetric measures. TAPSE <18 mm by CMR was strongly and independently associated with survival in PAH.
在肺动脉高压（PAH）患者中，通过心脏磁共振成像（CMR）获得的右心室（RV）功能二维测量比容积测量更快且具有高度可重复性，预测患者生存的能力相当。将CMR衍生的三尖瓣环平面收缩期位移（TAPSE）、RV短轴缩短率（RVFS）、RV面积变化分数（RVFAC）、标准功能和容积测量以及心室质量指数（VMI）与右心导管检查数据进行比较。记录CMR分析时间。使用受试者工作特征曲线、Kaplan-Meier曲线、Cox比例风险（CPH）模型和Bland-Altman检验进行分析。纳入了49例PAH患者和18例对照受试者。TAPSE、RVFS、RVFAC、RV射血分数和VMI与肺血管阻力和平均肺动脉压显著相关（所有P<0.05）。患者平均随访（±标准差）2.5±1.6年。Kaplan-Meier曲线显示，死亡与TAPSE<18mm、RVFS<16.7%和RVFAC<18.8%密切相关。在以18mm为分界点的TAPSE二分法的CPH模型中，TAPSE在未调整和调整模型中均与死亡风险显著相关（风险比，4.8；95%置信区间，2.0-11.3；TAPSE<18mm时P=0.005）。观察者内和观察者间一致性高。二维测量（1.5±0.3分钟）比容积测量（25±6分钟）更快。总之，TAPSE、RVFS和RVFAC测量是CMR评估RV功能的有效指标，与PAH严重程度的有创测量显著相关。在PAH患者中，TAPSE、RVFS和RVFAC具有高观察者内和观察者间可重复性，且比容积测量获取更快。CMR测量的TAPSE<18mm与PAH患者的生存密切且独立相关。
