Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka-shi, Fukuoka, Japan.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka-shi, Fukuoka, Japan.
Eur Radiol. 2019 Sep;29(9):4583-4592. doi: 10.1007/s00330-019-6008-3. Epub 2019 Feb 21.
To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA.
We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%.
ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = - 41.2, - 13.8, - 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = - 37.2, - 29.5, - 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56).
Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI.
• Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains. • Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA. • Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.
评估心脏 MRI（CMRI）右心室（RV）面积应变分析在无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者球囊肺动脉成形术（BPA）治疗效果评估中的作用，比较 BPA 前后二维（2D）应变与特征追踪 MRI（FTMRI）的 RV 面积应变。
我们回顾性分析了 21 例接受 BPA 的 CTEPH 患者。测量 BPA 前后收缩末期全局面积应变（GAS）、纵向应变（LS）、周向应变（CS）和径向应变（RS）。BPA 后 GAS 和 RV 射血分数（RVEF）值的变化定义为ΔGAS 和ΔRVEF。进行受试者工作特征（ROC）分析，以确定 BPA 后应变的最佳截断值，用于检测平均肺动脉压（mPAP）降低<30mmHg 和 RVEF 增加>50%的患者改善情况。
ROC 分析显示，用于识别 mPAP<30mmHg（截断（%）= -41.2、-13.8、-16.7 和 14.4：曲线下面积，0.75、0.56、0.65 和 0.75）和 RVEF>50%（截断（%）= -37.2、-29.5、-2.9 和 14.4：曲线下面积，0.81、0.60、0.56 和 0.56）的患者的应变（GAS、LS、CS 和 RS）最佳截断值。
CMRI 面积应变分析可能是评估 CTEPH 患者 BPA 治疗效果比 FTMRI 2D 应变更有用的工具。
面积应变值可以与二维应变一样或更准确地检测 BPA 后 RV 压力和功能的改善。
面积应变分析是一种有用的分析方法，可反映 BPA 后 RV 心肌变形的复杂改善。
面积应变分析是一种稳健的方法，与 2D 应变分析的重复性相当。
