Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Eur Heart J Cardiovasc Imaging. 2022 Dec 19;24(1):78-87. doi: 10.1093/ehjci/jeab294.
Precapillary pulmonary hypertension (pPH) affects left ventricular (LV) function by ventricular interdependence. Since LV ejection fraction (EF) is commonly preserved, LV dysfunction should be assessed with more sensitive techniques. Left atrial (LA) strain and estimation of LV intraventricular pressure gradients (IVPG) may be valuable in detecting subtle changes in LV mechanics; however, the value of these techniques in pPH is unknown. Therefore, the aim of our study is to evaluate LA strain and LV-IVPGs from cardiovascular magnetic resonance (CMR) cines in pPH patients.
In this cross-sectional study, 31 pPH patients and 22 healthy volunteers underwent CMR imaging. Feature-tracking LA strain was measured on four- and two-chamber cines. LV-IVPGs (from apex-base) are computed from a formulation using the myocardial movement and velocity of the reconstructed 3D-LV (derived from long-axis cines using feature-tracking). Systolic function, both LV EF and systolic ejection IVPG, was preserved in pPH patients. Compared to healthy volunteers, diastolic function was impaired in pPH patients, depicted by (i) lower LA reservoir (36 ± 7% vs. 26 ± 9%, P < 0.001) and conduit strain (26 ± 6% vs. 15 ± 8%, P < 0.001) and (ii) impaired diastolic suction (-9.1 ± 3.0 vs. ‒6.4 ± 4.4, P = 0.02) and E-wave decelerative IVPG (8.9 ± 2.6 vs. 5.7 ± 3.1, P < 0.001). Additionally, 11 pPH patients (35%) showed reversal of IVPG at systolic-diastolic transition compared to none of the healthy volunteers (P = 0.002).
pPH impacts LV function by altering diastolic function, demonstrated by an impairment of LA phasic function and LV-IVPG analysis. These parameters could therefore potentially be used as early markers for LV functional decline in pPH patients.
毛细血管前肺动脉高压（pPH）通过心室相互依赖影响左心室（LV）功能。由于 LV 射血分数（EF）通常保持不变，因此应使用更敏感的技术评估 LV 功能障碍。左心房（LA）应变和 LV 室内压力梯度（IVPG）的估计可能对检测 LV 力学的细微变化很有价值；然而，这些技术在 pPH 中的价值尚不清楚。因此，我们的研究目的是评估 pPH 患者心血管磁共振（CMR）电影中的 LA 应变和 LV-IVPG。
在这项横断面研究中，31 名 pPH 患者和 22 名健康志愿者接受了 CMR 成像。在四腔和两腔电影上测量特征追踪 LA 应变。LV-IVPG（从心尖到基底）是从使用心肌运动和重建的 3D-LV 速度（使用特征追踪从长轴电影得出）的公式计算得出的。与健康志愿者相比，pPH 患者的收缩功能，即 LV EF 和收缩期射血 IVPG，均保持不变。与健康志愿者相比，pPH 患者的舒张功能受损，表现为（i）LA 储备功能降低（36±7%比 26±9%，P<0.001）和导联应变降低（26±6%比 15±8%，P<0.001），以及（ii）舒张期抽吸受损（-9.1±3.0 比-6.4±4.4，P=0.02）和 E 波减速 IVPG 受损（8.9±2.6 比 5.7±3.1，P<0.001）。此外，与健康志愿者相比，11 名 pPH 患者（35%）在收缩-舒张转换时出现 IVPG 反转，而健康志愿者中无一例出现（P=0.002）。
pPH 通过改变 LA 时相功能和 LV-IVPG 分析来影响 LV 功能，表明 LV 功能障碍。因此，这些参数可能可作为 pPH 患者 LV 功能下降的早期标志物。
