Dept of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium.
Dpt of Cardiovascular Sciences, KU Leuven and Dept of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
J Heart Lung Transplant. 2022 Jan;41(1):86-94. doi: 10.1016/j.healun.2021.09.005. Epub 2021 Sep 16.
Right heart failure (RHF) in pulmonary hypertension (PH) patients is manifested by increased right atrial (RA) pressure. We hypothesized liver relaxation times measured at cardiovascular magnetic resonance (CMR) can be used to noninvasively assess increased right-sided filling pressure.
Forty-five consecutive patients, that is, 37 PH patients and 8 chronic thromboembolic pulmonary disease patients without PH underwent right heart catheterization and CMR. CMR findings were compared to 40 control subjects. Native T1, T2, and extracellular volume (ECV) liver values were measured on the cardiac maps.
Patients with increased RA pressure (i.e.,≥8 mm Hg)(n = 19, RA+ group) showed higher NT-proBNP and CRP values, lower LVEF, MAPSE values, larger atrial size, and higher native T1 and T2 values of the myocardium than patients with normal RA pressure (RA- group, n = 26). Liver T1, T2 and ECV was significantly higher in RA+ than RA- patients and controls, that is, T1: 684 ± 129 ms vs 563 ± 72 ms and 540 ± 34 ms; T2: 60 ± 10 ms vs 49 ± 6 ms and 46 ± 4 ms; ECV: 36 ± 8% vs 29 ± 4% and 30 ± 3%. A positive correlation was found between liver T1, T2 and ECV and RA pressure, that is, r of 0.61, 0.82, and 0.58, respectively (p < 0.001). ROC analysis to depict increased RA pressure showed an AUC of 0.847, 0.904, 0.816, and 0.645 for liver T1, T2, NT-proNBP and gamma-glutamyl transpeptidase, respectively. Excellent intra- and inter-observer agreement was found for assessment of T1/T2/ECV liver values.
Assessment of liver relaxation times as part of a comprehensive CMR exam in PH patients may provide valuable information with regard to the presence of passive liver congestion.
肺动脉高压（PH）患者的右心衰竭（RHF）表现为右心房（RA）压力增加。我们假设心血管磁共振（CMR）测量的肝脏弛豫时间可用于无创评估增加的右侧充盈压。
连续 45 例患者，即 37 例 PH 患者和 8 例无 PH 的慢性血栓栓塞性肺动脉高压患者进行了右心导管检查和 CMR。将 CMR 结果与 40 名对照进行比较。在心脏图谱上测量肝脏的原始 T1、T2 和细胞外容积（ECV）值。
RA 压力升高（即≥8mmHg）的患者（n=19，RA+组）的 NT-proBNP 和 CRP 值较高，LVEF、MAPSE 值较低，心房较大，心肌的原始 T1 和 T2 值较高，与 RA 压力正常的患者（RA-组，n=26）相比。与 RA-患者和对照组相比，RA+患者的肝脏 T1、T2 和 ECV 值显著升高，即 T1：684±129ms vs 563±72ms 和 540±34ms；T2：60±10ms vs 49±6ms 和 46±4ms；ECV：36±8% vs 29±4%和 30±3%。肝脏 T1、T2 和 ECV 与 RA 压力呈正相关，r 值分别为 0.61、0.82 和 0.58（p<0.001）。ROC 分析描绘 RA 压力升高，肝脏 T1、T2、NT-proNBP 和γ-谷氨酰转肽酶的 AUC 分别为 0.847、0.904、0.816 和 0.645。评估 T1/T2/ECV 肝脏值的观察者内和观察者间一致性均很好。
在 PH 患者的综合 CMR 检查中评估肝脏弛豫时间可能提供有关被动性肝充血存在的有价值的信息。
