Nishii Tatsuya, Horinouchi Hiroki, Namboku Takara, Sofue Keitaro, Asano Ryotaro, Kotoku Akiyuki, Ohta Yasutoshi, Ogo Takeshi, Fukuda Tetsuya
Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Int J Cardiovasc Imaging. 2024 Jul;40(7):1423-1434. doi: 10.1007/s10554-024-03119-6. Epub 2024 May 26.
This study examines the hepatic extracellular volume fraction (ECV) disparity between the left and right lobes (ECV_left and ECV_right) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), its association with right heart catheterization (RHC) metrics, and with intolerance to increased pulmonary hypertension (PH)-targeted medication dosages.
We retrospectively analyzed 72 CTEPH-diagnosed patients who underwent equilibrium-phase abdominal dual-energy CT (DECT) and RHC. Hepatic ECVs, derived from DECT's iodine maps using circular regions of interest in the liver and aorta, were correlated with RHC parameters via Spearman's rank correlation and lobe differences through the Wilcoxon signed-rank test. Logistic regression assessed cases with ECV_left exceeding ECV_right by > 0.05, while receiver operating characteristic curve analysis gauged ECVs' predictive power for medication intolerance.
Of the 72 patients (57 females; median age 69), ECV_total (0.24, IQR 0.20-0.27) moderately correlated with RHC parameters (r = 0.28, -0.24, 0.3 for mean pulmonary arterial pressure, cardiac index [CI], and pulmonary vascular resistance index, respectively). ECV_left significantly surpassed ECV_right (0.25 vs. 0.22, p < 0.001), with a greater ECV_left by > 0.05 indicating notably lower CI (p < 0.001). In 27 patients on PH medication, ECV_left effectively predicted medication intolerance (AUC = 0.84).
In CTEPH patients, hepatic ECV correlated with RHC metrics, where elevated left lobe ECV suggested reduced CI and potential medication intolerance.
本研究探讨慢性血栓栓塞性肺动脉高压（CTEPH）患者左右肝叶的肝细胞外容积分数（ECV）差异（ECV_left和ECV_right），及其与右心导管检查（RHC）指标以及对增加肺动脉高压（PH）靶向药物剂量不耐受的相关性。
我们回顾性分析了72例经诊断为CTEPH且接受了平衡期腹部双能CT（DECT）和RHC的患者。通过在肝脏和主动脉中使用圆形感兴趣区域从DECT碘图得出的肝ECV，通过Spearman等级相关性与RHC参数相关，并通过Wilcoxon符号秩检验分析叶间差异。逻辑回归评估ECV_left超过ECV_right大于0.05的病例，而受试者工作特征曲线分析评估ECV对药物不耐受的预测能力。
72例患者（57例女性；中位年龄69岁）中，ECV_total（0.24，四分位间距0.20 - 0.27）与RHC参数呈中度相关（分别与平均肺动脉压、心脏指数[CI]和肺血管阻力指数的r = 0.28、-0.24、0.3）。ECV_left显著超过ECV_right（0.25对0.22，p < 0.001），ECV_left大于0.05表明CI明显更低（p < 0.001）。在27例接受PH药物治疗的患者中，ECV_left有效预测了药物不耐受（曲线下面积 = 0.84）。
在CTEPH患者中，肝ECV与RHC指标相关，左叶ECV升高提示CI降低和潜在的药物不耐受。
