Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
J Magn Reson Imaging. 2024 Jul;60(1):350-362. doi: 10.1002/jmri.29044. Epub 2023 Oct 21.
Pulmonary hypertension (PH) results in right ventricular (RV) dysfunction, subsequently leading to left ventricular (LV) impairment. The mechanism underlying ventricular interdependence is largely uninvestigated.
To explore the biventricular dysfunction and the ventricular interdependence in PH patients.
Retrospective.
One hundred and seven PH patients (mean pulmonary artery pressure >20 mmHg) and 72 age- and sex-matched controls with cardiac magnetic resonance imaging (MRI) studies.
FIELD STRENGTH/SEQUENCE: 3.0 T/balanced steady-state free precession sequence.
LV and RV ejection fractions (EF) and RV and LV radial, circumferential, and longitudinal strains were assessed using commercial software. Strains were compared between controls, PH patients with preserved RVEF (RVEF ≥40%, N = 48), and PH patients with reduced RVEF (RVEF <40%, N = 59).
Chi-squared tests or Fisher's exact test, t tests or Mann-Whitney U test, one-way ANOVA with Bonferroni's post hoc correction or Kruskal-Wallis test, Pearson or Spearman correlation, and multivariable linear regression analysis. A two-tailed P < 0.05 was deemed statistically significant.
RV strain decreased sequentially from controls, through PH with preserved RVEF, to PH with reduced RVEF. PH patients with reduced RVEF had significantly lower LV strain, especially septal strain, and LV peak diastolic strain rate compared with both controls and PH patients with preserved RVEF. Multivariable analyses showed that RVEF was independently correlated with LV strain; furthermore, independent of RVEF, RV strain was significantly correlated with LV strain (LVGRS: β = 0.416; LVGCS: β = -0.371; LVGLS: β = 0.283).
Subclinical impairment of RV function was found in PH with preserved RVEF. LV strain was impaired when RV was dysfunctional, which was associated with worsening RV strain. Therefore, while focusing on improving RV function, LV dysfunction in PH patients should also be monitored and treated early in order to slow the progression of the disease.
3 TECHNICAL EFFICACY: Stage 3.
肺动脉高压（PH）可导致右心室（RV）功能障碍，随后导致左心室（LV）损伤。心室相互依存的机制在很大程度上尚未得到研究。
探讨 PH 患者的双心室功能障碍和心室相互依存关系。
回顾性研究。
107 例 PH 患者（平均肺动脉压>20mmHg）和 72 例年龄和性别匹配的心脏磁共振成像（MRI）研究对照者。
磁场强度/序列：3.0T/平衡稳态自由进动序列。
使用商业软件评估 LV 和 RV 射血分数（EF）以及 RV 和 LV 径向、周向和纵向应变。将对照者、PH 患者中保留 RV 射血分数（RVEF≥40%，N=48）和 PH 患者中降低 RV 射血分数（RVEF<40%，N=59）之间的应变进行比较。
卡方检验或 Fisher 确切检验，t 检验或 Mann-Whitney U 检验，单因素方差分析（Bonferroni 事后校正）或 Kruskal-Wallis 检验，Pearson 或 Spearman 相关，以及多变量线性回归分析。双侧 P<0.05 被认为具有统计学意义。
RV 应变依次从对照者、PH 患者中保留 RVEF 到 PH 患者中降低 RVEF 逐渐降低。与对照者和 PH 患者中保留 RVEF 相比，RVEF 降低的 PH 患者的 LV 应变明显降低，尤其是室间隔应变和 LV 舒张末期应变率。多变量分析显示，RVEF 与 LV 应变独立相关；此外，独立于 RVEF，RV 应变与 LV 应变显著相关（LVGRS：β=0.416；LVGCS：β=-0.371；LVGLS：β=0.283）。
在保留 RVEF 的 PH 中发现 RV 功能的亚临床损伤。当 RV 功能障碍时，LV 应变受损，这与 RV 应变恶化相关。因此，在关注改善 RV 功能的同时，还应早期监测和治疗 PH 患者的 LV 功能障碍，以减缓疾病进展。
3 级 技术功效：3 级
