Sato Takahiro, Tsujino Ichizo, Ohira Hiroshi, Oyama-Manabe Noriko, Ito Yoichi M, Takashina Chisa, Watanabe Taku, Nishimura Masaharu
First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan.
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
PLoS One. 2017 Nov 9;12(11):e0187806. doi: 10.1371/journal.pone.0187806. eCollection 2017.
Serial assessment of right ventricular ejection fraction (RVEF) predicts the clinical outcome of patients with pulmonary hypertension (PH). Cardiac magnetic resonance imaging (CMRI) enables RVEF monitoring, but its applicability is limited in clinical practice. This study aimed to examine the correlation between changes in CMRI-derived RVEF with those in echocardiographic indices in patients with precapillary PH.
CMRI and echocardiographic indices of RV systolic function were evaluated at baseline and follow-up in 54 consecutive patients with precapillary PH (pulmonary arterial hypertension (PAH), n = 23; non-PAH, n = 31). During follow-up, medical treatment was optimized according to the guidelines for PH. Using CMRI-derived RVEF as the gold standard, we examined the accuracy of five echocardiographic indices by correlation analysis and receiver operating characteristic (ROC) analysis and by calculating sensitivity, specificity, and positive and negative predictive values.
After an average period of 9.5 months, CMRI-derived RVEF improved from 30.2% ± 10.6% at baseline to 41.4% ± 11.3% at follow-up. These changes significantly correlated with those in the five echocardiographic indices, i.e., %RV fractional shortening (r = 0.27), %RV area change (r = 0.46), tricuspid annular plane systolic excursion (TAPSE) (r = 0.84), RV myocardial performance index (RVMPI) (r = -0.72), and systolic lateral tricuspid annular motion velocity (TVlat) (r = 0.66). Of these indices, %RV area change, TAPSE, and TVlat significantly correlated with those of CMRI-derived RVEF in both PAH and non-PAH subgroups. ROC analysis showed that improvement in echocardiographic indices predicted a pre-specified improvement in CMRI-derived RVEF (>2.9%), with TAPSE and TVlat showing better accuracy over the other three indices.
Echocardiographic indices modestly correlate with the changes in CMRI-derived RVEF in precapillary PH patients. Comparison among the five echocardiographic indices revealed that TAPSE and TVlat provide better accuracy than %RV fractional shortening, %RV area change, and RVMPI.
右心室射血分数（RVEF）的系列评估可预测肺动脉高压（PH）患者的临床结局。心脏磁共振成像（CMRI）能够监测RVEF，但在临床实践中其应用受到限制。本研究旨在探讨毛细血管前性PH患者CMRI衍生的RVEF变化与超声心动图指标变化之间的相关性。
对54例连续的毛细血管前性PH患者（肺动脉高压（PAH）23例，非PAH 31例）在基线和随访时进行CMRI及右心室收缩功能的超声心动图指标评估。随访期间，根据PH指南优化药物治疗。以CMRI衍生的RVEF作为金标准，通过相关性分析、受试者工作特征（ROC）分析以及计算敏感性、特异性、阳性和阴性预测值，来检验五个超声心动图指标的准确性。
平均9.5个月后，CMRI衍生的RVEF从基线时的30.2%±10.6%提高到随访时的41.4%±11.3%。这些变化与五个超声心动图指标的变化显著相关，即右心室短轴缩短率（%RV fractional shortening）（r = 0.27）、右心室面积变化率（%RV area change）（r = 0.46）、三尖瓣环平面收缩期位移（TAPSE）（r = 0.84）、右心室心肌做功指数（RVMPI）（r = -0.72）和三尖瓣环侧壁收缩期运动速度（TVlat）（r = 0.66）。在这些指标中，%RV面积变化、TAPSE和TVlat在PAH和非PAH亚组中均与CMRI衍生的RVEF显著相关。ROC分析显示，超声心动图指标的改善可预测CMRI衍生的RVEF预先设定的改善（>2.9%），其中TAPSE和TVlat的准确性优于其他三个指标。
超声心动图指标与毛细血管前性PH患者CMRI衍生的RVEF变化存在适度相关性。对五个超声心动图指标进行比较发现，TAPSE和TVlat的准确性优于右心室短轴缩短率、右心室面积变化率和右心室心肌做功指数。
