Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Am Heart J. 2018 Jul;201:136-140. doi: 10.1016/j.ahj.2018.04.013. Epub 2018 Apr 26.
The optimal interval between serial cardiac magnetic resonance imaging (CMRI) scans for monitoring right ventricular (RV) enlargement in the setting of severe pulmonic valve regurgitation (PR) is unknown. The purposes of this study were to (1) determine the annual change in RV volume on serial CMRI scans and (2) identify the risk factors for rapid progression of RV enlargement.
A retrospective study of adults with postintervention native valve PR and ≥2 CMRI scans at Mayo Clinic Rochester from 2000 to 2015 was conducted. Rapid progression of RV enlargement was defined as first upper quartile of annual increase in RV end-diastolic volume index (RVEDVi) for the cohort.
Of the 63 patients (age, 36 ± 9 years) in the study, 43 (68%) had tetralogy of Fallot, whereas 20 (32%) had valvular pulmonic stenosis. Right ventricular outflow tract interventions that resulted in PR were balloon pulmonary valvuloplasty (n = 4; 7%), transannular patch repair (n = 30; 58%), and nontransannular patch repair (n = 18; 35%). Interval between baseline and second CMRI was 2 (1-4) years. In comparison to baseline CMRI, RVEDVi increased from 130 (109-141) to 135 (126-155) mL/m and median annual change in RVEDVi was 3.1 (1.7-5.9) mL/m. Univariate risk factors for rapid progression of RV enlargement (annual increase in RVEDVi >6 mL/m) were ≥moderate tricuspid regurgitation and RVEDVi >130 mL/m. Among the 24 patients without these risk factors (low-risk subgroup), RVEDVi increased by only 3 (0-7) mL/m over 7 (5-9) years.
Patients with PR without RVEDVi >130 mL/m and/or ≥moderate tricuspid regurgitation represent a low-risk subgroup that may be appropriate for clinical and echo follow-up but may potentially require infrequent CMRI follow-up.
在严重肺动脉瓣反流（PR）的情况下，监测右心室（RV）扩大的连续心脏磁共振成像（CMRI）扫描的最佳间隔时间尚不清楚。本研究的目的是：（1）确定 RV 容积在连续 CMRI 扫描上的年度变化；（2）确定 RV 扩大快速进展的危险因素。
回顾性分析 2000 年至 2015 年在罗切斯特梅奥诊所接受介入治疗的原发性 PR 且至少有 2 次 CMRI 扫描的成年人。RV 舒张末期容积指数（RVEDVi）的年度增加首先达到队列的上四分位数，定义为 RV 扩大快速进展。
在这项研究的 63 名患者（年龄 36±9 岁）中，43 名（68%）患有法洛四联症，20 名（32%）患有瓣下肺动脉狭窄。导致 PR 的右心室流出道干预包括球囊肺动脉瓣成形术（n=4；7%）、跨瓣环补丁修复术（n=30；58%）和非跨瓣环补丁修复术（n=18；35%）。基线与第二次 CMRI 之间的间隔为 2（1-4）年。与基线 CMRI 相比，RVEDVi 从 130（109-141）增加到 135（126-155）mL/m，RVEDVi 的中位年变化为 3.1（1.7-5.9）mL/m。RV 扩大快速进展的单因素危险因素（RVEDVi 年增加>6mL/m）为≥中度三尖瓣反流和 RVEDVi>130mL/m。在没有这些危险因素的 24 名患者（低危亚组）中，RVEDVi 在 7（5-9）年内仅增加了 3（0-7）mL/m。
没有 RVEDVi>130mL/m 和/或≥中度三尖瓣反流的 PR 患者代表一个低危亚组，可能适合临床和超声随访，但可能需要较少的 CMRI 随访。
