Moriyama Hidenori, Murata Mitsushige, Tsugu Toshimitsu, Kawakami Takashi, Kataoka Masaharu, Hiraide Takahiro, Kimura Mai, Isobe Sarasa, Endo Jin, Kohno Takashi, Itabashi Yuji, Fukuda Keiichi
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Department of Laboratory Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Int J Cardiovasc Imaging. 2018 Jun;34(6):875-882. doi: 10.1007/s10554-017-1296-7. Epub 2017 Dec 30.
Chronic thromboembolic pulmonary hypertension (CTEPH) has a poor prognosis because of the associated progressive right heart failure. Accurate evaluation of right ventricular (RV) function would thus be useful to predict prognosis. However, the significance of RV diastolic function remains unclear. We aimed to identify which echocardiographic measures are most accurate, and potentially useful, in assessing RV diastolic function in patients with CTEPH, and to study the effects of balloon pulmonary angioplasty (BPA) on them. We enrolled 53 CTEPH patients who underwent BPA. Echocardiographic parameters, including two-dimensional speckle-tracking echocardiography, were compared to the hemodynamic parameters measured by right heart catheterization before and after BPA. RV strain rate during early diastole (SR_E), tricuspid e' and right atrial area (RAA) were ameliorated after BPA, concomitant with a decrease in the time constant of the RV pressure curve during diastole (tau), indicating the improvement of RV diastolic function. Among them, SR_E had the strongest correlation with tau (r = - 0.39, p < 0.001). Furthermore, the receiver operating characteristic analyses revealed that E/SR_E (AUC 0.704) and inferior vena cava diameter (AUC 0.726) had a stronger association with higher mean right atrial pressure than RAA (AUC 0.632). In contrast, RAA had a stronger correlation with 6 min-walk distances than SR_E (r = - 0.39, p < 0.001 vs. r = 0.30, p = 0.005). Taken together, echocardiographic assessment of RV diastolic function might be associated with hemodynamics as well as exercise tolerance in patients with CTEPH, indicating its benefits in evaluating the therapeutic effects of BPA.
慢性血栓栓塞性肺动脉高压（CTEPH）由于伴有进行性右心衰竭，预后较差。因此，准确评估右心室（RV）功能有助于预测预后。然而，RV舒张功能的意义仍不明确。我们旨在确定在评估CTEPH患者RV舒张功能时，哪些超声心动图测量方法最准确且可能有用，并研究球囊肺动脉血管成形术（BPA）对其的影响。我们纳入了53例行BPA的CTEPH患者。将包括二维斑点追踪超声心动图在内的超声心动图参数与BPA前后通过右心导管测量的血流动力学参数进行比较。BPA后，舒张早期RV应变率（SR_E）、三尖瓣e'和右心房面积（RAA）得到改善，同时RV压力曲线舒张期时间常数（tau）降低，表明RV舒张功能改善。其中，SR_E与tau的相关性最强（r = - 0.39，p < 0.001）。此外，受试者工作特征分析显示，与RAA（AUC 0.632）相比，E/SR_E（AUC 0.704）和下腔静脉直径（AUC 0.726）与较高的平均右心房压力的关联更强。相反，RAA与6分钟步行距离的相关性比SR_E更强（r = - 0.39，p < 0.001 vs. r = 0.30，p = 0.005）。综上所述，超声心动图评估RV舒张功能可能与CTEPH患者的血流动力学以及运动耐力相关，表明其在评估BPA治疗效果方面的益处。
