右心室限制性生理学与基于4D血流心脏磁共振成像的右心室直接血流相关。

Right Ventricular Restrictive Physiology Is Associated With Right Ventricular Direct Flow From 4D Flow CMR.

作者信息

Zhao Xiaodan, Lee Phong Teck, Hu Liwei, Tan Ru-San, Chai Ping, Yeo Tee Joo, Leng Shuang, Ouyang RongZhen, Bryant Jennifer Ann, Teo Lynette L S, van der Geest Rob J, Yip James W, Tan Ju Le, Zhong Yumin, Zhong Liang

机构信息

National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.

Duke-NUS Medical School, Singapore.

出版信息

JACC Asia. 2024 Oct 22;4(12):912-924. doi: 10.1016/j.jacasi.2024.08.019. eCollection 2024 Dec.

DOI:10.1016/j.jacasi.2024.08.019

PMID:39802994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11712013/

Abstract

BACKGROUND

Right ventricular restrictive physiology (RVRP) is a common occurrence in repaired tetralogy of Fallot (rTOF). The relationship of RVRP with biventricular blood flow components and kinetic energy (KE) from 4-dimensional (4D) flow cardiovascular magnetic resonance (CMR) is unclear.

OBJECTIVES

The purpose of this study was to investigate the association of 4D flow CMR parameters with RVRP in rTOF patients.

METHODS

A total of 103 rTOF patients and 62 age and sex-matched healthy control subjects were prospectively recruited. All participants underwent CMR (cine, 2-dimensional phase-contrast, and 4D flow sequences), and cardiopulmonary exercise test in adult populations. RVRP was identified from pulmonary artery flow curve using 2-dimensional phase-contrast images. Biventricular flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) and KE parameters normalized to end-diastolic volume (KEi) were analyzed encompassing global, peak systolic, average systolic, average diastolic, peak E-wave, and peak A-wave.

RESULTS

Compared with control subjects, rTOF patients had significantly lower RV direct flow and higher RV residual volume (both 0.001). All RV KEi parameters, except peak A-wave, were higher in rTOF patients. In rTOF patients, 70 of 103 (68%) had RVRP, with increasing RV direct flow (27% vs 20%; 0.002) and RV peak E-wave KEi (28.4 vs 20.7μJ/mL; 0.015) and decreasing RV residual volume (37% vs 42%; 0.039) than rTOF without RVRP. Exercise capacity was impaired in rTOF, although comparable between RVRP subgroups. Multivariable analysis revealed RV direct flow was an independent predictor of RVRP (OR: 1.158; 95% CI: 1.074-1.249; < 0.001).

CONCLUSIONS

RVRP is associated with dilated RV, higher pulmonary regurgitation, and higher RV direct flow. (Integrated Computational modeling of Right Heart Mechanics and Blood Flow Dynamics in Congenital Heart Disease; NCT03217240).

摘要

背景

右心室限制性生理（RVRP）在法洛四联症修复术后（rTOF）中很常见。RVRP与来自四维（4D）血流心血管磁共振（CMR）的双心室血流成分和动能（KE）之间的关系尚不清楚。

目的

本研究旨在探讨rTOF患者中4D血流CMR参数与RVRP之间的关联。

方法

前瞻性招募了103例rTOF患者和62例年龄及性别匹配的健康对照者。所有参与者均接受了CMR（电影、二维相位对比和4D血流序列）检查以及成人心肺运动试验。使用二维相位对比图像从肺动脉血流曲线中识别出RVRP。分析双心室血流成分（直接血流、保留流入、延迟射血血流和残余容积）以及以舒张末期容积标准化的KE参数（KEi），包括整体、收缩期峰值、平均收缩期、平均舒张期、E波峰值和A波峰值。

结果

与对照者相比，rTOF患者的右心室直接血流显著降低，右心室残余容积显著升高（均P<0.001）。rTOF患者中，除A波峰值外的所有右心室KEi参数均更高。在rTOF患者中，103例中有70例（68%）存在RVRP，与无RVRP的rTOF患者相比，其右心室直接血流增加（27%对20%；P=0.002）、右心室E波峰值KEi升高（28.4对20.7μJ/mL；P=0.015）且右心室残余容积降低（37%对42%；P=0.039）。rTOF患者的运动能力受损，尽管在RVRP亚组之间具有可比性。多变量分析显示右心室直接血流是RVRP的独立预测因素（OR：1.158；95%CI：1.074-1.249；P<0.001）。