Lindholm Anthony, Hesselstrand Roger, Rådegran Göran, Arheden Håkan, Ostenfeld Ellen
Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden.
Clin Physiol Funct Imaging. 2019 May;39(3):215-225. doi: 10.1111/cpf.12561. Epub 2019 Jan 16.
Patients with pulmonary arterial hypertension (PAH) due to systemic sclerosis (SSc) have high mortality. Left ventricular (LV) peak global longitudinal strain (GLS) is decreased in SSc. It is unknown whether low GLS is due to SSc or PAH. Therefore, our primary aim was to evaluate both LV and right ventricular free wall GLS (RVFW GLS) in SSc, with and without PAH, using cardiac magnetic resonance with feature tracking. Secondary aim was to relate GLS to invasive mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR).
Thirty-eight patients with SSc, 19 patients with SSc-PAH and 19 healthy controls for comparison, were included. Endocardial and epicardial borders were delineated in cine images (short-axis stack and three long-axis views) for volumetric and strain calculations.
Systemic sclerosis-PAH had lower LV and RVFW GLS than SSc (LV: P = 0·01, RV: P<0·001) and controls (LV: P = 0·02; RV: P<0·001), with no difference between SSc and controls. LV strain correlated with mPAP (R = 0·42, P = 0·03) and PVR (R = 0·52, P = 0·006). RVFW GLS correlated with mPAP (R = 0·68, P<0·001) and PVR (R = 0·59, P = 0·001). ROC curves for predicting PAH had AUC 0·73 for LV strain (P = 0·003) and 0·86 for RVFW GLS (P<0·001).
Lower GLS is mainly determined by increased pulmonary pressure and not by SSc per se. Low LV and RVFW GLS are indicative of increased mPAP and PVR, which opens for improved non-invasive methods to select patients eligible for right heart catheterization and to monitor the effects of PAH therapy.
系统性硬化症（SSc）所致肺动脉高压（PAH）患者死亡率较高。SSc患者左心室（LV）整体纵向应变峰值（GLS）降低。目前尚不清楚低GLS是由SSc还是PAH所致。因此，我们的主要目的是使用特征追踪心脏磁共振成像评估有或无PAH的SSc患者的左心室和右心室游离壁GLS（RVFW GLS）。次要目的是将GLS与有创平均肺动脉压（mPAP）和肺血管阻力（PVR）相关联。
纳入38例SSc患者、19例SSc-PAH患者以及19例作为对照的健康受试者。在电影图像（短轴堆栈和三个长轴视图）中勾勒心内膜和心外膜边界，以进行容积和应变计算。
与SSc患者（左心室：P = 0.01，右心室：P<0.001）和健康对照者（左心室：P = 0.02；右心室：P<0.001）相比，SSc-PAH患者的左心室和RVFW GLS较低，而SSc患者与健康对照者之间无差异。左心室应变与mPAP（R = 0.42，P = 0.03）和PVR（R = 0.52，P = 0.006）相关。RVFW GLS与mPAP（R = 0.68，P<0.001）和PVR（R = 0.59，P = 0.001）相关。预测PAH的ROC曲线中，左心室应变的曲线下面积（AUC）为0.73（P = 0.003），RVFW GLS的AUC为0.86（P<0.001）。
较低的GLS主要由肺动脉压力升高决定，而非SSc本身。左心室和RVFW GLS降低表明mPAP和PVR升高，这为改进无创方法以选择适合右心导管检查的患者并监测PAH治疗效果开辟了道路。
