心脏磁共振预测特发性肺动脉高压患者右心室收缩压的可行性研究  

The Feasibility of Cardiac Magnetic Resonance in the Prediction of the Right Ventricular Systolic Pressure in Patients with Idiopathic Pulmonary Arterial Hypertension

作　　者：郭劲松[1] 岳云龙[1] 金延方[1] 左利利[1] 潘磊[2] 王勇[2] 江宏[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院磁共振室,北京100038 [2]首都医科大学附属北京世纪坛医院干部医疗科,北京100038

出　　处：《临床放射学杂志》2017年第3期352-356,共5页Journal of Clinical Radiology

基　　金：北京市科委首都临床特色应用研究基金资助项目(编号:Z141107002514070)

摘　　要：目的评价使用CAD画图软件对心脏磁共振图像进行测量并计算室间隔和左心室游离壁的曲率比来预测特发性肺动脉高压患者右心室收缩压的准确性和可重复性。方法由两名医师利用第三方CAD画图软件测量、计算20例确诊为特发性肺动脉高压患者心脏磁共振收缩末期图像室间隔与左心室游离壁的曲率比。BlandAltman分析评估室间隔与左心室游离壁曲率比测量计算的可重复性。将CAD软件测量、计算的室间隔与左心室游离壁曲率比和右心导管检查测量、计算的室间隔与左心室游离壁跨壁压力差比进行线性回归分析得到回归方程,通过此方程计算出右心室收缩压。Bland-Altman分析评估计算得到的和右心导管测得的两组右心室收缩压的一致性。结果室间隔与左心室游离壁曲率比和室间隔与左心室游离壁跨壁压力差比呈显著线性相关(r=0.93)。经室间隔与左心室游离壁的曲率比计算得到的和右心导管测得的两组右心室收缩压一致性较好[平均差异(7.8±12.1)mm Hg]。结论使用CAD画图软件测量、计算心脏磁共振图像室间隔与左心室游离壁的曲率比简便、快速、可重复性好,测量得出的室间隔与左心室游离壁的曲率比可以较准确地预测特发性肺动脉高压患者的右心室收缩压。Objective To evaluate the accuracy and reproducibility of the cardiac magnetic resonance （CMR） imagingderived left ventricular septal-to-free wall curvature ratio by CAD drawing software for prediction of the right ventricular systolic pressure （RVSP） in patients with idiopathic pulmonary arterial hypertension （IPAH）. Methods Twenty patients with IPAH confirmed by right-side heart catheterization （RHC） underwent CMR imaging. Two doctors measured interven- tricular septal curvature （CIVS） and left ventricular free wall curvature （CFW） at end systole by using a third-party CAD drawing software and derived the curvature ratio （CIVS/CFW）. Pressure rise of IVS （dPIVS） and pressure rise of FW （dPFW） derived from RHC and systemic systolic blood pressure was used to derive the dP ratio （dPIVS/dPFW）. Interob- server and intraobserver curvature ratio measurements agreement was assessed by using Bland-Ahman analyses. Linear regression analysis was performed to assess the relationship between curvature ratio and dP ratio. A regression equation was derived. By using this equation, the RVSP was computed in every patient, and the agreement between CMR- and RHC-de- rived RVSPs was assessed by using Bland-Altman analysis. Results A direct linear correlation between curvature ratio and dP ratio was observed （r = 0.93 ）. Bland-Ahman analysis revealed moderate agreement between CMR- and RHC-derived RVSPs （mean difference = 7.8 ± 12.1 mm Hg）. Conclusion CMR-derived curvature ratio by CAD drawing software was a simple, fast, accurate and reproducible index for estimation of RVSP in patients with IPAH.

关 键 词：心脏磁共振 肺动脉高压 曲率比 右心室收缩压 

分 类 号：R544.1[医药卫生—心血管疾病] R445.2[医药卫生—内科学]