| 摘要: |
| 目的 应用心脏磁共振（CMR）测量右心室结构质量指数，评价其对肺动脉高压（PH）患者右心室功能受损的诊断能力。方法 回顾性纳入2015年1月至2019年1月于天津医科大学总医院经右心导管检查确诊的PH患者50例，包括右心室射血分数（RVEF）保留组（RVEF≥45%）17例和RVEF减低组（RVEF＜45%）33例；另纳入2014年2月至2016年6月于天津医科大学总医院接受CMR检查的健康志愿者25名为健康对照组。在CMR电影序列图像上手动勾画并经体表面积校正获得右心室结构质量指数，包括右心室心肌质量指数（RVMMI）、右心室小梁和乳头肌质量指数（RVTPMMI）、右心室隔缘肉柱质量指数（RVSMTMI）。对右心室结构质量指数与CMR常规心功能参数及右心导管检查指标进行相关性分析。对RVEF保留组与RVEF减低组间及RVEF保留组与健康对照组间差异有统计学意义的CMR参数进行ROC曲线分析，分别评价这些参数对PH患者右心室功能障碍或受损的诊断价值。结果 RVMMI、RVTPMMI、RVSMTMI测量用时分别为15（14，18）、20（17，22）、2（2，3）min。RVMMI、RVTPMMI、RVSMTMI与平均右心房压（mRAP）、平均肺动脉压（mPAP）、肺血管阻力（PVR）、右心室舒张末期容积指数（RVEDVI）均呈正相关，与混合静脉血氧饱和度（SvO2）、RVEF均呈负相关（P均＜0.01）。RVEF减低组的RVEDVI、右心室收缩末期容积指数（RVESVI）、RVMMI、RVTPMMI、RVSMTMI均高于RVEF保留组和健康对照组（P均＜0.05），RVEF保留组RVMMI、RVTPMMI、RVSMTMI均高于健康对照组（P均＜0.05）。ROC曲线分析结果显示，RVMMI、RVTPMMI、RVSMTMI对PH患者的右心室功能障碍、早期右心室功能受损均有较好的诊断效能（AUC值分别为0.864、0.894，0.829、0.864，0.842、0.953）。结论 CMR右心室结构质量指数RVMMI、RVTPMMI、RVSMTMI可以反映PH早期右心室形态学改变，对PH患者早期右心室功能受损有较好的诊断价值，其中RVSMTMI作为一个较为简便、直观的指标有潜力应用于临床实践。 |
| 关键词: 肺动脉高压 磁共振电影成像 右心室肥大 心肌 隔缘肉柱 小梁 乳头肌 |
| DOI：10.16781/j.CN31-2187/R.20220021 |
| 投稿时间：2022-01-07修订日期：2022-03-29 |
| 基金项目:中华国际医学交流基金会SKY影像科研基金（Z-2014-07-2003-05），国家自然科学基金（82071907），天津市自然科学基金（18JCYBJC25100），天津市卫生健康科技项目（MS20022）． |
|
| Quantitation of right ventricular trabecular and septomarginal trabecula mass by cardiac magnetic resonance in evaluating early impairment of right ventricular function in pulmonary hypertension patients |
| DU Ya-min1,ZHANG Zhang1,YANG Fan1,DENG Yuan-lin1,YAN Yan1,LI Yan-hong1,YANG Zhen-wen2,LI Dong1* |
(1. Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China;
2. Department of Cardiovasology, Tianjin Medical University General Hospital, Tianjin 300052, China
*Corresponding author) |
| Abstract: |
| Objective To assess the value of right ventricular (RV) structural mass parameters measured by cardiac magnetic resonance (CMR) in evaluating early impairment of RV function in pulmonary hypertension (PH) patients. Methods Fifty PH patients diagnosed by right heart catheterization in Tianjin Medical University General Hospital from Jan. 2015 to Jan. 2019 were retrospectively enrolled, including 17 patients in the preserved right ventricular ejection fraction (RVEF) group (RVEF ≥ 45%) and 33 patients in the reduced RVEF group (RVEF<45%); in addition, 25 healthy volunteers who underwent CMR in Tianjin Medical University General Hospital from Feb. 2014 to Jun. 2016 were included as healthy control group. The RV structural mass parameters such as right ventricular myocardial mass index (RVMMI), right ventricular trabecular and papillary muscle mass index (RVTPMMI), and right ventricular septomarginal trabecula mass index (RVSMTMI) were obtained by manually sketching on CMR cine images and calibrated by body surface area. Correlation analysis was used to analyze the relationship between RV structural mass parameters and CMR routine cardiac functional parameters and right heart catheterization parameters. The statistically significant parameters between the preserved RVEF group and reduced RVEF group and between the preserved RVEF group and healthy control group were analyzed using the receiver operating characteristic (ROC) curves, and the diagnostic value of these parameters in RV dysfunction or impairment in PH patients was evaluated. Results The time used for measurement of RVMMI, RVTPMMI, and RVSMTMI was 15 (14, 18), 20 (17, 22), and 2 (2, 3) min, respectively. RVMMI, RVTPMMI and RVSMTMI were positively correlated with mean right atrial pressure (mRAP), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and right ventricular end-diastolic volume index (RVEDVI), but negatively correlated with oxygen saturation in mixed venous blood (SvO2) and RVEF (all P<0.01). RVEDVI, right ventricular end-systolic volume index (RVESVI), RVEF, RVMMI, RVTPMMI and RVSMTMI in the reduced RVEF group were significantly higher than those in the preserved RVEF group (P<0.05); RVMMI, RVTPMMI and RVSMTMI in the preserved RVEF group were significantly higher than those in the healthy control group (all P<0.05). ROC curve analysis showed that RVMMI, RVTPMMI and RVSMTMI had good diagnostic performance for RV dysfunction and early RV impairment in PH patients (area under curve values were 0.864 and 0.894, 0.829 and 0.864, 0.842 and 0.953, respectively). Conclusion RV structural mass parameters (RVMMI, RVTPMMI and RVSMTMI) measured by CMR can reflect the early morphological changes of RV structures in PH patients, and have good diagnostic value for the early impairment of RV function in PH patients. Additionally, RVSMTMI, as a simple and intuitive index, has the potential for clinical application. |
| Key words: pulmonary hypertension magnetic resonance cine right ventricular hypertrophy myocardium septomarginal trabecula trabecula papillary muscle |
