三维相位对比磁共振成像对肺动脉高压患者肺动脉血流及壁面切应力的无创评估
Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging.
作者信息
Odagiri Keiichi, Inui Naoki, Hakamata Akio, Inoue Yusuke, Suda Takafumi, Takehara Yasuo, Sakahara Harumi, Sugiyama Masataka, Alley Marcus T, Wakayama Tetsuya, Watanabe Hiroshi
机构信息
Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan.
Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan.
出版信息
Springerplus. 2016 Jul 13;5(1):1071. doi: 10.1186/s40064-016-2755-7. eCollection 2016.
BACKGROUND
Recently, time-resolved 3D phase contrast magnetic resonance imaging (4D-flow) allows flow dynamics in patients with pulmonary arterial hypertension to be measured. Abnormal flow dynamics, such as vortex blood flow pattern in the pulmonary artery (PA), may reflect progression of pulmonary arterial hypertension (PAH). Some reports suggested that abnormal blood flow parameters including wall shear stress (WSS) could be markers of PAH. However, it was not fully assessed clinical usefulness of these variables. We aimed to assess whether these flow dynamic parameters, such as vortex formation time (VFT) and WSS, were associated with right ventricular (RV) function.
RESULTS
Fifteen subjects, nine with PAH and six healthy volunteers, underwent 4D-flow. Differences of Blood flow patterns, blood flow velocities and WSS between PAH patients and healthy volunteers were evaluated. We also assessed the association between VFT, WSS and RV function in PAH patients. Both vortex blood flow patterns and early systolic retrograde flow in the main PA were observed in all patients with PAH. The PA flow velocities and WSS in patients with PAH were lower than those in healthy volunteers, but that blood flow volumes in the MPA, RPA and LPA and SV in the MPA were broadly comparable between the groups. The mean VFT was 35.0 ± 16.6 % of the cardiac cycle. The VFT significantly correlated with RV ejection fraction, RV end systolic volume, and RV end systolic volume index (RVEF = 75.1 + (-85.7)·VFT, p = 0.003, RVESV = 12.4 + 181.8·VFT, p = 0.037 and RVESVI = 10.6 + 114.8·VFT, p = 0.038, respectively) in PAH patients, whereas WSS did not correlate with RV function.
CONCLUSIONS
We confirmed that abnormal blood flow dynamics, including the vortex formation and the early onset of retrograde flow, low WSS in the PA were characteristics of PAH. The VFT may be associated with right ventricular dysfunction, whereas WSS was not. Our results suggest that 4D-flow is an effective means of detecting right heart failure as well as diagnosing PAH.
CLINICAL TRIAL REGISTRATION URL
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi. Unique identifier: UMIN000011128.
背景
最近，时间分辨三维相位对比磁共振成像（4D血流）能够测量肺动脉高压患者的血流动力学。异常的血流动力学，如肺动脉（PA）中的涡流血流模式，可能反映肺动脉高压（PAH）的进展。一些报告表明，包括壁面切应力（WSS）在内的异常血流参数可能是PAH的标志物。然而，这些变量的临床实用性尚未得到充分评估。我们旨在评估这些血流动力学参数，如涡流形成时间（VFT）和WSS，是否与右心室（RV）功能相关。
结果
15名受试者，9名PAH患者和6名健康志愿者接受了4D血流检查。评估了PAH患者和健康志愿者之间的血流模式、血流速度和WSS的差异。我们还评估了PAH患者中VFT、WSS与RV功能之间的关联。所有PAH患者均观察到涡流血流模式和主肺动脉的收缩早期逆向血流。PAH患者的肺动脉血流速度和WSS低于健康志愿者，但两组之间主肺动脉、右肺动脉和左肺动脉的血流量以及主肺动脉的每搏输出量大致相当。平均VFT为心动周期的35.0±16.6%。在PAH患者中，VFT与右心室射血分数、右心室收缩末期容积和右心室收缩末期容积指数显著相关（RVEF = 75.1 + (-85.7)·VFT，p = 0.003；RVESV = 12.4 + 181.8·VFT，p = 0.037；RVESVI = 10.6 + 114.8·VFT，p = 0.038），而WSS与RV功能无关。
结论
我们证实，包括涡流形成、逆向血流早期出现以及肺动脉低WSS在内的异常血流动力学是PAH的特征。VFT可能与右心室功能障碍有关，而WSS则无关。我们的结果表明，4D血流是检测右心衰竭以及诊断PAH的有效手段。
临床试验注册网址
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi。唯一标识符：UMIN000011128。
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