Crowe Tim, Jayasekera Geeshath, Peacock Andrew J
41444 Cardiac and Vascular Imaging Group, Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK.
Pulm Circ. 2018 Jan-Mar;8(1):2045893217742000. doi: 10.1177/2045893217742000. Epub 2017 Oct 24.
Pulmonary hypertension (PH) is a progressive illness characterized by elevated pulmonary artery pressure; however, the main cause of mortality in PH patients is right ventricular (RV) failure. Historically, improving the hemodynamics of pulmonary circulation was the focus of treatment; however, it is now evident that cardiac response to a given level of pulmonary hemodynamic overload is variable but plays an important role in the subsequent prognosis. Non-invasive tests of RV function to determine prognosis and response to treatment in patients with PH is essential. Although the right ventricle is the focus of attention, it is clear that cardiac interaction can cause left ventricular dysfunction, thus biventricular assessment is paramount. There is also focus on the atrial chambers in their contribution to cardiac function in PH. Furthermore, there is evidence of regional dysfunction of the two ventricles in PH, so it would be useful to understand both global and regional components of dysfunction. In order to understand global and regional cardiac function in PH, the most obvious non-invasive imaging techniques are echocardiography and cardiac magnetic resonance imaging (CMRI). Both techniques have their advantages and disadvantages. Echocardiography is widely available, relatively inexpensive, provides information regarding RV function, and can be used to estimate RV pressures. CMRI, although expensive and less accessible, is the gold standard of biventricular functional measurements. The advent of 3D echocardiography and techniques including strain analysis and stress echocardiography have improved the usefulness of echocardiography while new CMRI technology allows the measurement of strain and measuring cardiac function during stress including exercise. In this review, we have analyzed the advantages and disadvantages of the two techniques and discuss pre-existing and novel forms of analysis where echocardiography and CMRI can be used to examine atrial, ventricular, and interventricular function in patients with PH at rest and under stress.
肺动脉高压（PH）是一种以肺动脉压力升高为特征的进行性疾病；然而，PH患者的主要死亡原因是右心室（RV）衰竭。从历史上看，改善肺循环的血流动力学是治疗的重点；然而，现在很明显，心脏对给定水平的肺血流动力学超负荷的反应是可变的，但在随后的预后中起着重要作用。对PH患者进行右心室功能的非侵入性测试以确定预后和对治疗的反应至关重要。虽然右心室是关注的焦点，但很明显心脏相互作用可导致左心室功能障碍，因此双心室评估至关重要。在PH中，心房对心脏功能的贡献也受到关注。此外，有证据表明PH患者的两个心室存在局部功能障碍，因此了解功能障碍的整体和局部成分将是有用的。为了了解PH患者的整体和局部心脏功能，最明显的非侵入性成像技术是超声心动图和心脏磁共振成像（CMRI）。这两种技术都有其优缺点。超声心动图应用广泛、相对便宜，可提供有关右心室功能的信息，并可用于估计右心室压力。CMRI虽然昂贵且不易获得，但却是双心室功能测量的金标准。三维超声心动图以及包括应变分析和负荷超声心动图在内的技术的出现提高了超声心动图的实用性，而新的CMRI技术允许测量应变并在包括运动在内的负荷状态下测量心脏功能。在本综述中，我们分析了这两种技术的优缺点，并讨论了现有的和新颖的分析形式，其中超声心动图和CMRI可用于检查PH患者在静息和负荷状态下的心房、心室和心室间功能。
