Wang Lei, Zhou Weihua, Liang Yu, Yang Yong, Garcia Ernest V, Chen Ji, Fang Wei
Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, United Kingdom.
J Nucl Cardiol. 2017 Feb;24(1):69-78. doi: 10.1007/s12350-015-0341-y. Epub 2015 Dec 29.
Right ventricular (RV) performance in patients of pulmonary hypertension (PH) requires optimal assessment. The objective of this study is to develop phase analysis using F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as a feasible tool for evaluation of RV dyssynchrony in PH.
Fifty-four PH patients with well-characterized hemodynamic parameters were enrolled. All subjects performed FDG-PET imaging for RV phase analysis and RV function evaluation. Two-dimensional echocardiography with speckle tracking analysis was conducted to obtain RV time to peak systolic strain (PSST) as a comparison. The median contraction delay difference between RV middle free wall and septum measured by PET phase analysis (RVPD) was 20.12° (interquartile range, 4.99°-30.10°). The median difference of PSST between RV middle free wall and middle septal wall (RVPD) measured by echocardiography was 43.98° (interquartile range, 6.25°-72.00°). RVPD was well correlated with RVPD (r = 0.685, P < .001). RV phase standard deviation (RVSD) and histogram bandwidth (RVBW) derived from PET phase histogram were significantly correlated with cardiac index, RV ejection fraction, 6-minute walking distance, and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) (RVSD: r = -0.532, P < .001; r = -0.551, P < .001; r = -0.544, P < .001; r = 0.404, P < .01; respectively, RVBW: r = -0.492, P < .001; r = -0.466, P < .001; r = -0.544, P < .001; r = 0.349, P = .01, respectively), while there were no significant correlations between RVSD and RVBW with hemodynamic parameters (right atrial pressure, right ventricular systolic pressure, right ventricular end-diastolic pressure, mean pulmonary artery pressure, and total pulmonary resistance).
Contraction delays between RV free wall and septum in PH measured by phase analysis and speckle tracking echocardiography were well correlated. RV dyssynchrony measured by phase analysis of FDG-PET was significantly related to RV dysfunction. Phase analysis of FDG-PET is feasible to evaluate RV mechanical dyssynchrony in patients of PH.
肺动脉高压（PH）患者的右心室（RV）功能需要进行最佳评估。本研究的目的是开发利用F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）成像进行相位分析，作为评估PH患者右心室不同步的可行工具。
纳入54例血流动力学参数明确的PH患者。所有受试者均进行FDG-PET成像以进行右心室相位分析和右心室功能评估。同时进行二维斑点追踪超声心动图检查，以获取右心室收缩期峰值应变时间（PSST）作为对照。通过PET相位分析测量的右心室中间游离壁与室间隔之间的收缩延迟中位数差异（RVPD）为20.12°（四分位间距，4.99°-30.10°）。通过超声心动图测量的右心室中间游离壁与中间室间隔壁之间的PSST中位数差异（RVPD）为43.98°（四分位间距，6.25°-72.00°）。RVPD与RVPD相关性良好（r = 0.685，P <.001）。PET相位直方图得出的右心室相位标准差（RVSD）和直方图带宽（RVBW）与心脏指数、右心室射血分数、6分钟步行距离和血清N末端B型脑钠肽前体（NT-proBNP）显著相关（RVSD：r = -0.532，P <.001；r = -0.551，P <.001；r = -0.544，P <.001；r = 0.404，P <.01；RVBW：r = -0.492，P <.001；r = -0.466，P <.001；r = -0.544，P <.001；r = 0.349，P =.01），而RVSD和RVBW与血流动力学参数（右心房压力、右心室收缩压、右心室舒张末期压力、平均肺动脉压力和总肺阻力）之间无显著相关性。
通过相位分析和斑点追踪超声心动图测量的PH患者右心室游离壁与室间隔之间的收缩延迟相关性良好。通过FDG-PET相位分析测量的右心室不同步与右心室功能障碍显著相关。FDG-PET相位分析可用于评估PH患者的右心室机械不同步。
