肺动脉高压右心负荷的多模态评估——代谢与临床后果。
Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension.
机构信息
Department of Cardiology, Medical University of Bialystok, Białystok, Poland.
Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
出版信息
J Cardiovasc Magn Reson. 2021 May 10;23(1):49. doi: 10.1186/s12968-021-00743-2.
BACKGROUND
In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients.
METHODS
Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload-pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUV. Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration.
RESULTS
Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUV). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (-)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R = 0.68; p < 0.001).
CONCLUSIONS
Coupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients.
TRIAL REGISTRATION
NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689.
背景
在肺动脉高压（PAH）中，后负荷增加导致右心室（RV）的适应性过程，有助于维持 RV 的动静脉耦联并保持心输出量，但随着时间的推移，适应性机制会失效。在这项研究中，我们提出了一种多模态方法，该方法可以评估 RV 耦联参数在 PAH 患者中的预后价值。
方法
27 例稳定的 PAH 患者（49.5±15.5 岁）和 12 例对照者接受了心血管磁共振（CMR）检查。采用 CMR 特征追踪分析评估 RV 整体纵向应变（RV GLS）。RV-动脉耦联通过 RV GLS 与三个提出的 RV 后负荷替代物（肺动脉收缩压[PASP]、肺血管阻力[PVR]和肺动脉顺应性[PAC]）的组合来评估。18-FDG 正电子发射断层扫描（PET）分析用于评估 RV 葡萄糖摄取，表现为 SUV。本研究的随访时间为 25 个月，临床终点定义为死亡或临床恶化。
结果
耦联参数（RV GLS/PASP、RV GLS/PVR 和 RV GLS*PAC）与 RV 功能和标准化摄取值（SUV）显著相关。发生临床终点（n=18）的患者在基线检查时的耦联参数明显较差。RV GLS/PASP 在预测临床终点方面具有最高的曲线下面积，且值高于（-）0.29%/mmHg 的患者预后明显较差。在多变量分析中，它也是临床终点的统计学显著预测因子（调整后的 R=0.68；p<0.001）。
结论
耦联参数与 PAH 中的 RV 血液动力学和葡萄糖代谢有关。CMR 和血液动力学测量相结合，可以更全面地评估 RV 功能，从而预测 PAH 患者的预后。
试验注册
NCT03688698，2018 年 9 月 26 日，回顾性注册；方案 ID：2017/25/N/NZ5/02689。
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