心脏磁共振室间隔曲率对成人房间隔缺损肺动脉高压的诊断价值  

The value of interventricular septal curvature in the diagnosis of adult pulmonary artery hypertension associated with atrial septal defect by cardiac magnetic resonance

作　　者：张宝美 胡春峰 程守全 张诗文 邱萍 梁妍 王诚 ZHANG Baomei;HU Chunfeng;CHENG Shouquan;ZHANG Shiwen;QIU Ping;LIANG Yan;WANG Cheng(Department of Cardiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Imaging,the Affiliated Hospital of Xuzhou Medical University;Department of Cardiology,Huai′an First People′s Hospital,Huai′an,Jiangsu 223001)

机构地区：[1]徐州医科大学附属医院心内科,江苏徐州221002 [2]徐州医科大学附属医院影像科 [3]淮安市第一人民医院心内科,江苏淮安223001

出　　处：《徐州医科大学学报》2021年第4期261-266,共6页Journal of Xuzhou Medical University

摘　　要：目的运用心脏磁共振(CMR)分析室间隔形态与右心导管检查指标的相关性,评估室间隔曲率(C_(IVS))对肺动脉高压(PAH)患者的诊断价值。方法回顾性分析32例成人房间隔缺损患者的右心导管及CMR数据。根据平均肺动脉压力(mPAP)是否≥25 mmHg(1 mmHg=0.133 kPa)分成2组:肺动脉高压组(PAH组)和肺动脉压力正常组(NPAH组)。比较2组患者CMR参数,分析C_(IVS)与CMR参数、右心导管指标的相关性,采用受试者工作特征曲线(ROC曲线)分析C_(IVS)判断PAH的敏感度及特异度。结果 32例成人房间隔缺损患者中有16例患者合并肺动脉高压,与NPAH组相比PAH组舒张末期C_(IVS)降低(P<0.01),而收缩末期C_(IVS)的差异无统计学意义。相关性分析显示,舒张末期C_(IVS)与mPAP(r=-0.85,P<0.01)、肺动脉收缩压(r=-0.75,P<0.01)、肺动脉舒张压(r=-0.84,P<0.01)显著相关。ROC曲线显示舒张末期C_(IVS)诊断PAH具有很高的效能ROC曲线下面积(AUC)=0.94特异度为94%,敏感度为81%。结论在成人房间隔缺损的患者中,舒张末期C_(IVS)可作为无创评估PAH的重要指标。Objective To analyze the correlation between interventricular septum morphology and right heart catheterization indexes by cardiac magnetic resonance(CMR),and to evaluate the use of interventricular septum curvature(C IVS)in diagnosis of patients with pulmonary artery hypertension(PAH).Methods Retrospective analysis was performed where RHC and CMR data were collected from 32 adult patients with atrial septal defect(ASD).According to their mean pulmonary artery pressure(mPAP),the patients were divided into two groups:a PAH group(≥25 mmHg)and a non-PAH(NPAH)group.Both groups were compared for CMR parameters,and the correlation between C IVS and CMR parameters and RHC measurements was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the use of C IVS for detection of PAH.Results In the current study,there were 16 ASD patients with PAH.Compared with the NPAH group,end-diastolic C IVS(dC IVS)decreased in the PAH group(P<0.01);and no statistical difference was found in end systolic C IVS between the two groups.There were significant correlations between dC IVS and mPAP(r=-0.85,P<0.01),between dC IVS and systolic pulmonary artery pressure(sPAP)(r=-0.75,P<0.01),between dC IVS and diastolic pulmonary artery pressure(dPAP)(r=-0.84,P<0.01).The ROC showed that dC IVS was effective for diagnosis of PAH.The AUC was 0.94,with a specificity of 94%and a sensitivity of 81%.Conclusions For adult ASD with PAH,dC IVS can be used as an important index for noninvasive evaluation of PAH.

关 键 词：心脏磁共振 室间隔曲率 肺动脉高压 右心导管术 

分 类 号：R541.1[医药卫生—心血管疾病]