Sevilla Teresa, Baladrón Carlos, de Miguel-Álava María, Rojas-Lavado Gino, González-Bartol Esther, Revilla-Orodea Ana, Aristizabal-Duque Cristhian, Carrasco-Moraleja Manuel, Fernández-Garrote Miguel, San Román J Alberto
Cardiology Department, Hospital Clínico Universitario de Valladolid, Ramón y Cajal 3, 47003, Valladolid, Spain.
Centro de Investigación Biomédica en Red, CIBER-CV, Monforte de Lemos 3-5, 28029, Madrid, Spain.
Eur Radiol. 2025 Apr;35(4):2180-2188. doi: 10.1007/s00330-024-11045-3. Epub 2024 Aug 30.
To evaluate the prognostic value of transit time (TT) assessment in the systemic circulation and organ perfusion in patients with ventricular dysfunction (VD). The primary endpoint was defined as death, heart failure admission, or ventricular arrhythmias, and the secondary endpoint was worsening renal function.
A retrospective study on 139 patients who underwent cardiac magnetic resonance for VD evaluation and 50 controls. TT was measured as peak-to-peak time in signal intensity over time curves obtained at different stages of circulation (right cavities, left cavities, aorta, and peripheral organs) from first-pass perfusion images. Outcomes were monitored over a median follow-up of 15 months.
A total of 139 patients were included (84% male, age 63 [57-70] years). Patients exhibited significantly prolonged TT compared to controls, with in-patients showing longer times than outpatients. Among the 29 patients reaching the primary endpoint, both PTT and STT were significantly prolonged (PTT: 9.75 s vs 13.4 s, p < 0.01; STT: 4.77 s vs 7.00 s, p < 0.01). Concurrent prolongation of PTT (> 10 s) and STT (> 5 s) was associated with a higher event probability (42.3%), compared to isolated abnormalities (6.3% for PTT, 6.7% for STT). Multivariate analysis revealed that combined PTT and STT alteration independently predicted the combined endpoint (HR IC 95%: 8.685 (2.415-31.236), p = 0.001). Prolonged RPT was independently associated with renal function deterioration (OR IC 95%: 1.129 (1.015-1.256), p = 0.024).
Evaluation of TT beyond pulmonary circulation provides prognostic insights into VD. Simultaneous assessment of PTT and STT enhances specificity compared to isolated PTT evaluation, predicting combined adverse events. RPT is independently associated with renal impairment.
For the first time, it is described that transit time can be evaluated in systemic circulation and in peripheral organs and that this assessment can be easily made from conventional CMR perfusion images and holds significant prognostic value.
Pulmonary transit time is a valuable hemodynamic parameter; systemic transit time may also be valuable. Transit time can be measured in the systemic circulation, and is longer in patients with ventricular dysfunction. Systemic transit time assessed by magnetic resonance imaging identifies patients with ventricular dysfunction who will experience events during follow-up.
评估心室功能不全（VD）患者体循环和器官灌注中通过时间（TT）评估的预后价值。主要终点定义为死亡、心力衰竭入院或室性心律失常，次要终点为肾功能恶化。
对139例接受心脏磁共振成像以评估VD的患者及50例对照者进行回顾性研究。TT通过首次通过灌注图像在循环不同阶段（右心腔、左心腔、主动脉和外周器官）获得的信号强度随时间曲线中的峰峰值时间来测量。在中位随访15个月期间监测结局。
共纳入139例患者（84%为男性，年龄63[57 - 70]岁）。与对照组相比，患者的TT显著延长，住院患者的时间长于门诊患者。在达到主要终点的29例患者中，PTT和STT均显著延长（PTT：9.75秒对13.4秒，p<0.01；STT：4.77秒对7.00秒，p<0.01）。与单独异常（PTT为6.3%，STT为6.7%）相比，PTT（>10秒）和STT（>5秒）同时延长与更高的事件概率相关（42.3%）。多变量分析显示，PTT和STT联合改变独立预测联合终点（HR IC 95%：8.685[2.415 - 31.236]，p = 0.001）。RPT延长与肾功能恶化独立相关（OR IC 95%：1.129[1.015 - 1.256]，p = 0.024）。
评估肺循环以外的TT可为VD提供预后见解。与单独评估PTT相比，同时评估PTT和STT可提高特异性，预测联合不良事件。RPT与肾功能损害独立相关。
首次描述了可在体循环和外周器官中评估通过时间，且该评估可通过传统CMR灌注图像轻松进行，并具有重要的预后价值。
肺通过时间是一个有价值的血流动力学参数；体循环通过时间可能也有价值。通过时间可在体循环中测量，在心室功能不全患者中更长。通过磁共振成像评估的体循环通过时间可识别在随访期间将发生事件的心室功能不全患者。
