Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Department of Biomedical Imaging and Image guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Eur Heart J Cardiovasc Imaging. 2020 Jun 1;21(6):683-691. doi: 10.1093/ehjci/jez221.
Increased afterload to the right ventricle (RV) has been shown to induce myocardial fibrosis at the RV insertion points (RVIPs). Such changes can be discrete but potentially detected by cardiac magnetic resonance (CMR) T1-mapping. Whether RVIP fibrosis is associated with prognosis in heart failure with preserved ejection fraction (HFpEF) is unknown.
We prospectively investigated 167 consecutive HFpEF patients, a population frequently suffering from post-capillary pulmonary hypertension, who underwent CMR including T1-mapping. About 92.8% also underwent right heart catheterization for haemodynamic assessment.Native T1 times were 995 ± 73 ms at the anterior and 1040 ± 90 ms at the inferior RVIP. By Spearman's rank order testing, RVIP T1 times were significantly correlated with pulmonary artery pressure (mean PAP, r = 0.313 and 0.311 for anterior and inferior RVIP), pulmonary artery wedge pressure (r = 0.301 and 0.251) and right atrial pressure (r = 0.245 and 0.185; P for all <0.05). During a mean follow-up of 43.2 ± 22.6 months, 30 (18.0%) subjects died. By multivariable Cox regression, NTproBNP [Hazard ratio (HR) 2.105, 95% confidence interval (CI) 1.332-3.328; P = 0.001], systolic PAP (HR 1.618, 95% CI 1.175-2.230; P = 0.003), and native T1 time of the anterior RVIP (HR 1.659, 95% CI 1.125-2.445; P = 0.011) were significantly associated with outcome. Also, by Kaplan-Meier analysis, T1 times at the anterior RVIPs had a significant effect on survival (log-rank, P = 0.002).
Interstitial expansion of the anterior RVIP as detected by CMR T1-mapping reflects haemodynamic alterations, and is independently related with prognosis in HFpEF.
研究发现，右心室（RV）后负荷增加会导致 RV 插入点（RVIP）心肌纤维化。这种变化可能是离散的，但可以通过心脏磁共振（CMR）T1 映射检测到。在射血分数保留的心力衰竭（HFpEF）患者中，RVIP 纤维化是否与预后相关尚不清楚。
我们前瞻性研究了 167 例连续的 HFpEF 患者，这些患者常患有毛细血管后肺动脉高压，他们接受了包括 T1 映射在内的 CMR 检查。大约 92.8%的患者还接受了右心导管检查以进行血流动力学评估。RVIP 的固有 T1 时间在前 RVIP 为 995 ± 73ms，在下 RVIP 为 1040 ± 90ms。通过 Spearman 等级相关检验，RVIP 的 T1 时间与肺动脉压（平均 PAP，前 RVIP 和下 RVIP 的 r 值分别为 0.313 和 0.311）、肺动脉楔压（r 值分别为 0.301 和 0.251）和右心房压（r 值分别为 0.245 和 0.185；P 值均<0.05）显著相关。在平均 43.2 ± 22.6 个月的随访期间，有 30 名（18.0%）患者死亡。多变量 Cox 回归分析显示，N 末端脑钠肽前体（HR 2.105，95%置信区间（CI）1.332-3.328；P=0.001）、收缩压 PAP（HR 1.618，95%CI 1.175-2.230；P=0.003）和前 RVIP 的固有 T1 时间（HR 1.659，95%CI 1.125-2.445；P=0.011）与结局显著相关。此外，通过 Kaplan-Meier 分析，前 RVIP 的 T1 时间对生存有显著影响（对数秩检验，P=0.002）。
CMR T1 映射检测到的前 RVIP 间质扩张反映了血流动力学的改变，与 HFpEF 的预后独立相关。
