Göransson Christoffer, Vejlstrup Niels, Carlsen Jørn
Department of Cardiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.
Pulm Circ. 2022 Jul 1;12(3):e12097. doi: 10.1002/pul2.12097. eCollection 2022 Jul.
Right ventricular (RV) dilatation predicts clinical worsening in pulmonary arterial hypertension (PAH) and RV volumes can be measured with high precision using cardiovascular magnetic resonance imaging. In regular follow-up of patients and in studies of improvement in RV function, knowledge of clinically significant changes of RV volumes and function are of relevance. Patients with PAH were followed with cardiovascular magnetic resonance imaging and clinical assessment at 6-month intervals. Changes in RV volumes associated with changes in clinical status were assessed. Twenty-five patients with PAH (Group 1) were included and examined every 6 months for 2.5 years, with a total of 107 MRI scans. For a step change in WHO functional class, the associated change in RV volume was 11% (confidence interval 7%-14%, < 0.0001) and in stroke volume 9% (confidence interval 3%-15%, = 0.003). This study found an 11% change in RV volume to be clinically significant. The combination of clinically significant changes and the known precision in the measurements enables individualized follow-up of RV-function in PAH. To our knowledge, this study is the first to use repeated assessments to suggest clinically significant changes of RV volume based on changes in clinical presentation.
右心室（RV）扩张可预测肺动脉高压（PAH）患者的临床病情恶化，并且使用心血管磁共振成像能够高精度地测量RV容积。在对患者进行定期随访以及研究RV功能改善情况时，了解RV容积和功能具有临床意义的变化至关重要。对PAH患者每隔6个月进行一次心血管磁共振成像检查和临床评估，评估与临床状态变化相关的RV容积变化。纳入25例PAH患者（第1组），每6个月检查一次，共进行2.5年，总计107次MRI扫描。对于世界卫生组织功能分级的阶梯式变化，RV容积的相关变化为11%（置信区间7%-14%，P＜0.0001），每搏输出量的相关变化为9%（置信区间3%-15%，P = 0.003）。本研究发现RV容积11%的变化具有临床意义。具有临床意义的变化与已知测量精度相结合，能够对PAH患者的RV功能进行个体化随访。据我们所知，本研究是首次利用重复评估根据临床表现变化提示RV容积具有临床意义的变化。
