Department of Cardiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA.
Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Research 2 - Building P15, 12700 E 19th Avenue, Aurora, CO 80045-2560, USA.
Eur Heart J Cardiovasc Imaging. 2018 Apr 1;19(4):415-424. doi: 10.1093/ehjci/jex069.
To investigate the possibility that vorticity assessed by four-dimensional flow cardiac magnetic resonance (4D-Flow CMR) in the left ventricle of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is a potential marker of early LV diastolic dysfunction (LVDD) and more sensitive than standard echocardiography, and whether changes in vorticity are associated with quantitative computed tomography (CT) and clinical markers of COPD, and right ventricular (RV) echocardiographic markers indicative of ventricular interdependency.
Sixteen COPD patients with presumptive LVDD and 10 controls underwent same-day 4D-Flow CMR and Doppler echocardiography to quantify early and late diastolic vorticity as well as standard evaluation for LVDD. Furthermore, all patients underwent detailed CT analysis for COPD markers including percent emphysema and air trapping. The 4D-Flow CMR derived diastolic vorticity measures were correlated with CT measures, standard clinical and CMR markers, and echocardiographic diastolic RV metrics. Early diastolic vorticity was significantly reduced in COPD patients (P < 0.0001) with normal left ventricular (LV) mass, geometry, systolic function, and no or mild signs of Doppler LVDD when compared with controls. Vorticity significantly differentiated COPD patients without echocardiographic signs of LVDD (n = 11) from controls (P < 0.0001), and from COPD patients with stage I LVDD (n = 5) (P < 0.0180). Vorticity markers significantly correlated with CT computed measures, CMR-derived RV ejection fraction, echocardiographic RV diastolic metrics, and 6-minute walk test.
4D-Flow CMR derived diastolic vorticity is reduced in patients with mild-to-moderate COPD and no or mild signs of LVDD, implying early perturbations in the LV flow domain preceding more obvious mechanical changes (i.e. stiffening and dilation). Furthermore, reduced LV vorticity appears to be driven by COPD induced changes in lung tissue and parallel RV dysfunction.
研究通过四维血流心脏磁共振（4D-Flow CMR）评估轻度至中度慢性阻塞性肺疾病（COPD）患者左心室涡流的可能性，其是否为早期左心室舒张功能障碍（LVDD）的潜在标志物，并且比标准超声心动图更敏感，以及涡流的变化是否与定量计算机断层扫描（CT）和 COPD 的临床标志物以及提示心室相互依赖性的右心室（RV）超声心动图标志物相关。
16 名疑似 LVDD 的 COPD 患者和 10 名对照者在同一天接受 4D-Flow CMR 和多普勒超声心动图检查，以量化早期和晚期舒张期涡流以及 LVDD 的标准评估。此外，所有患者均接受详细的 CT 分析，以评估 COPD 标志物，包括肺气肿百分比和空气滞留。4D-Flow CMR 衍生的舒张期涡流测量值与 CT 测量值、标准临床和 CMR 标志物以及超声心动图舒张期 RV 指标相关。与对照组相比，COPD 患者的早期舒张期涡流明显减少（P<0.0001），但左心室（LV）质量、几何形状、收缩功能正常，且没有或仅有轻度多普勒 LVDD 迹象。与对照组（P<0.0001）和阶段 I LVDD（n=5）的 COPD 患者（P<0.0180）相比，涡流明显区分了无超声心动图 LVDD 迹象的 COPD 患者（n=11）。涡流标志物与 CT 计算测量值、CMR 衍生的 RV 射血分数、超声心动图 RV 舒张指标和 6 分钟步行测试显著相关。
在轻度至中度 COPD 患者中，4D-Flow CMR 衍生的舒张期涡流减少，且没有或仅有轻度 LVDD 迹象，表明在更明显的机械变化（即僵硬和扩张）之前，LV 流域的早期扰动。此外，LV 涡流减少似乎是由 COPD 引起的肺组织变化和并行 RV 功能障碍引起的。
