Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85, Lund, Sweden.
Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
Int J Cardiovasc Imaging. 2022 Oct;38(10):2235-2248. doi: 10.1007/s10554-022-02616-w. Epub 2022 Apr 23.
To investigate if left and right atrioventricular plane displacement (AVPD) or regional contributions to SV are prognostic for outcome in patients with pulmonary arterial hypertension (PAH). Seventy-one patients with PAH and 20 sex- and age-matched healthy controls underwent CMR. Myocardial borders and RV insertion points were defined at end diastole and end systole in cine short-axis stacks to compute biventricular volumes, lateral (SV) and septal (SV) contribution to stroke volume. Eight atrioventricular points were defined at end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views for computation of AVPD and longitudinal contribution to stroke volume (SV). Cut-off values for survival analysis were defined as two standard deviations above or below the mean of the controls. Outcome was defined as death or lung transplantation. Median follow-up time was 3.6 [IQR 3.7] years. Patients were 57 ± 19 years (65% women) and controls 58 ± 15 years (70% women). Biventricular AVPD, SV and ejection fraction (EF) were lower and SV was higher, while SV was lower in PAH compared with controls. In PAH, transplantation-free survival was lower below cut-off for LV-AVPD (hazard ratio [HR] = 2.1, 95%CI 1.2-3.9, p = 0.02) and RV-AVPD (HR = 9.8, 95%CI 4.6-21.1, p = 0.005). In Cox regression analysis, lower LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR = 1.16, p = 0.007; RV: HR = 1.11, p = 0.01; per mm decrease). LV-SV, RV-SV, LV-SV, RV-SV, SV and LV- and RVEF did not affect outcome. Low left and right AVPD were associated with outcome in PAH, but regional contributions to stroke volume and EF were not.
为了探究左、右房室平面位移（AVPD）或 SV 的区域性贡献是否对肺动脉高压（PAH）患者的预后具有预测价值。71 名 PAH 患者和 20 名性别和年龄匹配的健康对照者接受了 CMR 检查。在电影短轴堆栈的舒张末期和收缩末期定义心肌边界和 RV 插入点，以计算双心室容积、侧壁（SV）和间隔（SV）对心搏量的贡献。在 2、3 和 4 腔电影长轴视图的舒张末期和收缩末期定义 8 个房室点，以计算 AVPD 和 SV 对心搏量的纵向贡献。生存分析的截断值定义为对照组平均值上下两个标准差。将结局定义为死亡或肺移植。中位随访时间为 3.6 [IQR 3.7] 年。患者年龄为 57±19 岁（65%为女性），对照组为 58±15 岁（70%为女性）。与对照组相比，PAH 患者的双心室 AVPD、SV 和射血分数（EF）较低，SV 较高，而 SV 较低。在 PAH 中，左心室 AVPD（HR=2.1，95%CI 1.2-3.9，p=0.02）和右心室 AVPD（HR=9.8，95%CI 4.6-21.1，p=0.005）低于截断值的患者，无移植生存率较低。在 Cox 回归分析中，较低的 LV-AVPD 和 RV-AVPD 提示无移植生存率较低（LV：HR=1.16，p=0.007；RV：HR=1.11，p=0.01；每毫米降低）。LV-SV、RV-SV、LV-SV、RV-SV、SV 和 LV 和 RV-EF 均未影响结局。左、右 AVPD 降低与 PAH 患者的结局相关，但 SV 的区域性贡献和 EF 无相关性。
