Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany.
Eur J Radiol. 2022 Feb;147:110111. doi: 10.1016/j.ejrad.2021.110111. Epub 2021 Dec 17.
The aim of this study was to assess effects of balloon pulmonary angioplasty (BPA) on right ventricular (RV) mechanical dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) via MRI.
MRI at 1.5 Tesla and right heart catheterization were performed before and 6 months after BPA in 30 CTEPH patients (mean age 63.4 ± 10.6 years; 17 female). Feature-tracking strain analysis, including global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain, was performed and compared with right ventricular function, myocardial remodelling (assessed by native T1 times), and pulmonary haemodynamics (mean pulmonary arterial pressure and pulmonary vascular resistance).
RVEF (35.9% to 48.4%) increased and mPAP (42.1 mmHg to 33.1 mmHg) and PVR (551.8 to 377.7 dyn∙s/cm) decreased after BPA (all p < 0.0001). Moreover, RV strain increased (GLS -19.9 to -24.0%, p = 0.0003; GCS -9.4 to -11.0%, p = 0.0022; GRS 38.2 to 50.7%, p = 0.001) and septal native area-adjusted T1 time (AA-T1) decreased (1019.4 to 988.7 ms, p < 0.0001). GLS revealed the best correlations with RVEF (before BPA r = -0.75; after BPA r = -0.54), mPAP (r = 0.36; r = 0.52), PVR (r = 0.49; r = 0.48), and AA-T1 (r = 0.44; 0.19).
RV mechanical dysfunction, pulmonary haemodynamics, and myocardial remodelling are markedly improved by BPA. Moreover, RV strain values showed good correlations with RV function, pulmonary haemodynamics, and myocardial remodelling. Therefore, strain analysis might provide new insights regarding therapy outcome, monitoring, and prognosis.
本研究旨在通过 MRI 评估球囊肺动脉成形术（BPA）对无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者右心室（RV）机械功能障碍的影响。
在 30 例 CTEPH 患者（平均年龄 63.4 ± 10.6 岁；17 名女性）中，在 BPA 前和 6 个月后分别进行 1.5T MRI 和右心导管检查。进行特征追踪应变分析，包括整体纵向应变（GLS）、整体圆周应变（GCS）和整体径向应变（GRS），并与右心室功能、心肌重构（通过原生 T1 时间评估）和肺血流动力学（平均肺动脉压和肺血管阻力）进行比较。
BPA 后 RVEF（35.9%至 48.4%）增加，mPAP（42.1mmHg 至 33.1mmHg）和 PVR（551.8dyn·s/cm 至 377.7dyn·s/cm）降低（均 p < 0.0001）。此外，RV 应变增加（GLS-19.9%至-24.0%，p = 0.0003；GCS-9.4%至-11.0%，p = 0.0022；GRS 38.2%至 50.7%，p = 0.001），间隔区原生面积校正 T1 时间（AA-T1）降低（1019.4ms 至 988.7ms，p < 0.0001）。GLS 与 RVEF（BPA 前 r = -0.75；BPA 后 r = -0.54）、mPAP（r = 0.36；r = 0.52）、PVR（r = 0.49；r = 0.48）和 AA-T1（r = 0.44；r = 0.19）的相关性最好。
BPA 可显著改善 RV 机械功能障碍、肺血流动力学和心肌重构。此外，RV 应变值与 RV 功能、肺血流动力学和心肌重构具有良好的相关性。因此，应变分析可能为治疗效果、监测和预后提供新的见解。
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