Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany.
Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany; Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Acad Radiol. 2018 Dec;25(12):1540-1547. doi: 10.1016/j.acra.2018.04.002. Epub 2018 May 2.
The aim of this study was to assess regional myocardial function in patients with chronic thromboembolic hypertension (CTEPH) before and after successful pulmonary endarterectomy (PEA) using magnetic resonance imaging.
Twenty-two patients with CTEPH underwent cardiac magnetic resonance imaging before and 12 (11, 17) days after PEA. Mean pulmonary artery pressure was evaluated preoperatively by right heart catheterization and during post-PEA intensive care unit-stay using a Swan-Ganz catheter. Biventricular peak systolic longitudinal, radial, circumferential strain and time-to-peak strain were obtained by tissue-tracking analysis.
Mean pulmonary artery pressure decreased (46 mm Hg (34.5, 55) to 24 mm Hg (16, 27); P < .0001) and stroke volume increased (P < .0001) after PEA. In the right ventricle (RV) peak radial strain increased in the anterior (P = .04) and in the inferior wall (P = .0012) and slightly missed statistical significance in the lateral wall (P = .051) and septum (P = .07). Circumferential strain increased in the lateral (P = .0002) and inferior wall of the RV (P = .03) and in the lateral as well as in the inferior wall of the left ventricle (P = .01; P = .03). Radial, longitudinal, and circumferential time-to-peak strain shortened (P < .0001) with resynchronization of the ventricles 12 days after PEA.
While biventricular resynchronization and recovery of global predominantly RV function was observed, regional circumferential function mainly improved in the lateral and inferior walls of both ventricles and regional radial function in the RV wall and septum 12 days after PEA, suggesting fibers primarily affected by myocardial stress in patients with CTEPH possibly need a relatively longer recovery time.
本研究旨在使用磁共振成像评估慢性血栓栓塞性高血压（CTEPH）患者肺动脉内膜剥脱术（PEA）前后的区域性心肌功能。
22 例 CTEPH 患者在 PEA 前和 PEA 后 12（11、17）天进行心脏磁共振成像。术前通过右心导管检查评估平均肺动脉压，PEA 后 ICU 入住期间通过 Swan-Ganz 导管进行监测。通过组织追踪分析获得双心室收缩期峰值纵向、径向、环向应变和应变达峰时间。
PEA 后平均肺动脉压降低（46mmHg（34.5、55）至 24mmHg（16、27）；P＜0.0001），心输出量增加（P＜0.0001）。右心室（RV）峰值径向应变在前壁（P=0.04）和下壁（P=0.0012）增加，侧壁（P=0.051）和室间隔（P=0.07）略微错过统计学意义。RV 外侧壁和下壁的环向应变增加（P=0.0002，P=0.03），左心室的外侧壁和下壁的环向应变增加（P=0.01，P=0.03）。径向、纵向和环向应变达峰时间缩短（P＜0.0001），PEA 后 12 天心室再同步。
尽管观察到双心室再同步和 RV 功能的全球恢复，但 12 天后主要在 RV 壁的外侧和下壁以及双心室的外侧壁和下壁改善了区域性环向功能，RV 壁和室间隔的局部径向功能，提示 CTEPH 患者可能需要相对较长的恢复时间来恢复心肌张力所影响的纤维。
