Sato Takahiro, Ambale-Venkatesh Bharath, Zimmerman Stefan L, Tedford Ryan J, Hsu Steven, Chamera Ela, Fujii Tomoki, Mullin Christopher J, Mercurio Valentina, Khair Rubina, Corona-Villalobos Celia P, Simpson Catherine E, Damico Rachel L, Kolb Todd M, Mathai Stephen C, Lima Joao A C, Kass David A, Tsujino Ichizo, Hassoun Paul M
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pulm Circ. 2021 Sep 24;11(4):20458940211032529. doi: 10.1177/20458940211032529. eCollection 2021 Oct-Dec.
Right ventricular function has prognostic significance in patients with pulmonary hypertension. We evaluated whether cardiac magnetic resonance-derived strain and strain rate parameters could reliably reflect right ventricular systolic and diastolic function in precapillary pulmonary hypertension. End-systolic elastance and the time constant of right ventricular relaxation tau, both derived from invasive high-fidelity micromanometer catheter measurements, were used as gold standards for assessing systolic and diastolic right ventricular function, respectively. Nineteen consecutive precapillary pulmonary hypertension patients underwent cardiac magnetic resonance and right heart catheterization prospectively. Cardiac magnetic resonance data were compared with those of 19 control subjects. In pulmonary hypertension patients, associations between strain- and strain rate-related parameters and invasive hemodynamic parameters were evaluated. Longitudinal peak systolic strain, strain rate, and early diastolic strain rate were lower in PAH patients than in controls; peak atrial-diastolic strain rate was higher in pulmonary hypertension patients. Similarly, circumferential peak systolic strain rate was lower and peak atrial-diastolic strain rate was higher in pulmonary hypertension. In pulmonary hypertension, no correlations existed between cardiac magnetic resonance-derived and hemodynamically derived measures of systolic right ventricular function. Regarding diastolic parameters, tau was significantly correlated with peak longitudinal atrial-diastolic strain rate ( = -0.61), deceleration time ( = 0.75), longitudinal systolic to diastolic time ratio ( = 0.59), early diastolic strain rate ( = -0.5), circumferential peak atrial-diastolic strain rate ( = -0.52), and deceleration time ( = 0.62). Strain analysis of the right ventricular diastolic phase is a reliable non-invasive method for detecting right ventricular diastolic dysfunction in PAH.
右心室功能对肺动脉高压患者具有预后意义。我们评估了心脏磁共振衍生的应变和应变率参数是否能可靠地反映毛细血管前性肺动脉高压患者的右心室收缩和舒张功能。分别来自侵入性高保真微测压导管测量的收缩末期弹性和右心室舒张时间常数tau,被用作评估右心室收缩和舒张功能的金标准。19例连续的毛细血管前性肺动脉高压患者前瞻性地接受了心脏磁共振和右心导管检查。将心脏磁共振数据与19名对照受试者的数据进行比较。在肺动脉高压患者中,评估应变和应变率相关参数与侵入性血流动力学参数之间的关联。肺动脉高压患者的纵向收缩期峰值应变、应变率和舒张早期应变率低于对照组;肺动脉高压患者的心房舒张期峰值应变率较高。同样,肺动脉高压患者的圆周收缩期峰值应变率较低,心房舒张期峰值应变率较高。在肺动脉高压中,心脏磁共振衍生的和血流动力学衍生的右心室收缩功能测量值之间不存在相关性。关于舒张参数,tau与纵向心房舒张期峰值应变率(r = -0.61)、减速时间(r = 0.75)、纵向收缩期与舒张期时间比(r = 0.59)、舒张早期应变率(r = -0.5)、圆周心房舒张期峰值应变率(r = -0.52)和减速时间(r = 0.62)显著相关。右心室舒张期应变分析是检测肺动脉高压患者右心室舒张功能障碍的可靠非侵入性方法。