Wang Lili, Chen Xiaoling, Wan Ke, Gong Chao, Li Weihao, Xu Yuanwei, Wang Jie, He Juan, Wen Bi, Han Yuchi, Zeng Rui, Chen Yucheng
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China.
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, P. R. China.
Pulm Circ. 2020 Apr 9;10(2):2045894019899778. doi: 10.1177/2045894019899778. eCollection 2020 Apr-Jun.
The right ventricle experiences dynamic changes under pressure overload in pulmonary artery hypertension. This study aimed to evaluate the diagnostic and prognostic value of right ventricular eccentricity index (RVEI) in pulmonary artery hypertension. A total of 100 pulmonary artery hypertension patients (mean age, 36.85 (SD, 13.60) years; males, 30.0%) confirmed by right heart catheterization and 147 healthy volunteers (mean age 45.58 (SD, 17.58) years; males, 42.50%) were enrolled in this prospective study. All participants underwent cardiac magnetic resonance imaging (MRI) examination, and balanced steady-state free precession (bSSFP) cine sequences were acquired. RVEI was measured on short-axis cine images at the mid-ventricular level of the right ventricle in end systole. The study found that RVEI was significantly lower in pulmonary artery hypertension patients than in healthy volunteers (1.84 (SD, 0.40) vs. 2.46 (SD, 0.40); p < 0.001). In pulmonary artery hypertension patients, RVEI was correlated with log(NT-proBNP) (r = -0.388; p < 0.001), right ventricular end-diastolic volume index (r = -0.452; p < 0.001), right ventricular end-systolic volume index (r = -0.518; p < 0.001), and right ventricular ejection fraction (r = 0.552; p < 0.001). RVEI could discriminate pulmonary artery hypertension patients from healthy volunteers with 91.8% sensitivity and 68.0% specificity. Over median follow-up of 14.8 months (interquartile range: 6.7-26.9 months), RVEI was demonstrated to be an independent predictor for adverse outcome (HR = 0.076; 95% CI, 0.013-0.458; p = 0.005). In conclusion, MRI-derived RVEI appears to be a useful diagnostic and prognostic value in pulmonary artery hypertension, and it provides incremental value to risk stratification strategy.
在肺动脉高压中，右心室在压力过载下会经历动态变化。本研究旨在评估右心室偏心指数（RVEI）在肺动脉高压中的诊断和预后价值。共有100例经右心导管检查确诊的肺动脉高压患者（平均年龄36.85（标准差13.60）岁；男性占30.0%）和147名健康志愿者（平均年龄45.58（标准差17.58）岁；男性占42.50%）纳入了这项前瞻性研究。所有参与者均接受了心脏磁共振成像（MRI）检查，并采集了平衡稳态自由进动（bSSFP）电影序列。在右心室收缩末期的心室中部水平的短轴电影图像上测量RVEI。研究发现，肺动脉高压患者的RVEI显著低于健康志愿者（1.84（标准差0.40）对2.46（标准差0.40）；p < 0.001）。在肺动脉高压患者中，RVEI与log（NT-proBNP）（r = -0.388；p < 0.001）、右心室舒张末期容积指数（r = -0.452；p < 0.001）、右心室收缩末期容积指数（r = -0.518；p < 0.001）以及右心室射血分数（r = 0.552；p < 0.001）相关。RVEI能够以91.8%的敏感性和68.0%的特异性区分肺动脉高压患者和健康志愿者。在中位随访14.8个月（四分位间距：6.7 - 26.9个月）期间，RVEI被证明是不良结局的独立预测因素（HR = 0.076；95%置信区间，0.013 - 0.458；p = 0.005）。总之，MRI衍生的RVEI在肺动脉高压中似乎具有有用的诊断和预后价值，并且它为风险分层策略提供了增量价值。
