Yamasaki Yuzo, Nagao Michinobu, Abe Kohtaro, Hosokawa Kazuya, Kawanami Satoshi, Kamitani Takeshi, Yamanouchi Torahiko, Horimoto Koshin, Yabuuchi Hidetake, Honda Hiroshi
Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Int J Cardiovasc Imaging. 2017 Feb;33(2):229-239. doi: 10.1007/s10554-016-0985-y. Epub 2016 Sep 26.
To use cardiac magnetic resonance imaging (MRI) to investigate the effect of balloon pulmonary angioplasty (BPA) on interventricular dyssynchrony and its associations with ventricular interaction, which impairs LV function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This prospective observational study was approved by our institutional review board. Cardiac MRI and right heart catheterization were conducted before BPA sessions and at the follow up after BPA in 20 patients with CTEPH. We measured right ventricular (RV) and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using MRI. For the LV and RV free walls, the time to peak (T) of circumferential strain was calculated as a parameter for interventricular dyssynchrony. Following BPA, the RV-EDV and -ESV were significantly decreased, and the RVEF was significantly increased. Conversely, BPA led to significantly increased LV EDV and SV without changing LVESV. The left-to-right free wall delay (L-R delay) in T strain decreased from 105 ± 44 ms to 47 ± 67 ms (p < 0.001). Increased LV EDV (r = 0.65, p < 0.01), SV (r = 0.74, p < 0.001) and 6-minute walk distance (6MWD) (r = 0.54, p < 0.05) were correlated to the reduction in L-R delay. In patients with inoperable CPEPH, BPA improved interventricular dyssynchrony, which was strongly associated with increased SV and 6MWD. The assessment of interventricular dyssynchrony using cardiac MRI has an important role in evaluating ventricular interaction, which reduces LVSV and exercise tolerance.
利用心脏磁共振成像（MRI）研究球囊肺动脉血管成形术（BPA）对心室不同步的影响及其与心室相互作用的关联，心室相互作用会损害无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的左心室功能。这项前瞻性观察性研究已获得我们机构审查委员会的批准。对20例CTEPH患者在进行BPA治疗前及BPA治疗后的随访时进行了心脏MRI和右心导管检查。我们使用MRI测量了右心室（RV）和左心室（LV）的舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）和射血分数（EF）。对于左心室和右心室游离壁，计算圆周应变的峰值时间（T）作为心室不同步的参数。BPA治疗后，右心室EDV和ESV显著降低，右心室射血分数显著增加。相反，BPA导致左心室EDV和SV显著增加，而左心室ESV无变化。T应变的左右游离壁延迟（L-R延迟）从105±44毫秒降至47±67毫秒（p<0.001）。左心室EDV增加（r=0.65，p<0.01）、SV增加（r=0.74，p<0.001）和6分钟步行距离（6MWD）增加（r=0.54，p<0.05）与L-R延迟的缩短相关。在无法手术的CPEPH患者中，BPA改善了心室不同步，这与SV增加和6MWD增加密切相关。使用心脏MRI评估心室不同步在评估心室相互作用方面具有重要作用，心室相互作用会降低左心室每搏输出量和运动耐量。
