1 Department of Nuclear Medicine, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China.
2 Hubei Key Laboratory of Molecular Imaging, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China.
Exp Biol Med (Maywood). 2018 May;243(9):754-761. doi: 10.1177/1535370218775321.
Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients' long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m (Tc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients. Furthermore, myocardial perfusion imaging was not observed in the normal subjects but in pulmonary arterial hypertension patients, especially severe pulmonary arterial hypertension subgroup, and showed potential diagnostic properties for pulmonary arterial hypertension. In conclusion, mean pulmonary arterial pressure levels are correlated with several right heart catheterization and echocardiography markers in pulmonary arterial hypertension patients; echocardiography and Tc myocardial perfusion can be used to evaluate right ventricle performance in pulmonary arterial hypertension patients. Impact statement In this study, we analyzed the clinical parameters for evaluating RV function, including right ventricle catheterization (RHC), echocardiography, and technetium 99m (Tc) myocardial perfusion imaging (MPI) in normal Asian subjects and PAH patients ( n = 23 for each group). Our results demonstrated that six RHC indexes, four echocardiography indexes and MPI index were significantly altered in PAH patients and correlated with the levels of mean pulmonary arterial pressure. Importantly, we evaluated the diagnostic performance of MPI and found that MPI has a strong diagnostic accuracy in PAH patients. The findings from this study will be of interest to clinical investigators who make diagnosis and therapeutic strategies for PAH patients.
右心导管检查常用于测量右心室血流动力学参数，是肺动脉高压诊断的金标准；然而，它不适合患者的长期随访。非侵入性超声心动图和核医学已被用于测量右心室解剖和功能，但临床参数有用性的指南仍有待建立。本研究的目的是确定肺动脉高压患者右心室功能的可靠临床参数，并分析这些临床参数与肺动脉高压严重程度的关系。在这项研究中，2015 年 1 月至 2016 年 3 月期间共招募了 23 名正常受试者和 23 名肺动脉高压患者。根据平均肺动脉压水平，肺动脉高压患者被分为中度和重度肺动脉高压组。所有受试者均接受体格检查、胸部 X 线、12 导联心电图、右心导管检查、二维超声心动图和锝 99m（Tc）心肌灌注成像。与正常受试者相比，肺动脉高压患者的右心导管检查指标包括右心室收缩压、右心室舒张末期压、肺动脉收缩压、肺动脉舒张压、肺血管阻力和右心室收缩末期压均升高，并与平均肺动脉压水平相关。超声心动图参数，包括三尖瓣反流峰值速度、三尖瓣反流压力梯度、三尖瓣环平面收缩期位移和分数面积、右心室-心肌性能指数，与肺动脉高压患者的平均肺动脉压水平显著相关。此外，正常受试者中未见心肌灌注成像，但在肺动脉高压患者中，尤其是重度肺动脉高压亚组中可见，并显示出对肺动脉高压的潜在诊断特性。总之，平均肺动脉压水平与肺动脉高压患者的几项右心导管检查和超声心动图标志物相关；超声心动图和 Tc 心肌灌注可用于评估肺动脉高压患者的右心室功能。
