心脏磁共振成像对左向右分流型先天性心脏病合并肺动脉高压的诊断价值及右心室功能评估  

Diagnostic value of cardiac magnetic resonance to left-to-right shunt congenital heart disease complicated by pulmonary arterial hypertension and reviewing of right ventricular function

作　　者：梁妍 胡春峰 程守全 谢冰 张诗文 李志强 刘鑫 王诚 Liang Yan;Hu Chunfeng;Cheng Shouquan;Xie Bing;Zhang Shiwen;Li Zhiqiang;Liu Xin;Wang Cheng(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China.)

机构地区：[1]徐州医科大学附属医院心内科,徐州221000 [2]徐州医科大学附属医院影像科,徐州221000

出　　处：《中国循证心血管医学杂志》2022年第1期79-83,86,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨心脏磁共振成像(CMR)对左向右分流型先天性心脏病(CHD)合并肺动脉高压(PAH)的诊断效能及对患者右心室功能的评价作用。方法选取2012年9月至2020年7月就诊于徐州医科大学附属医院确诊为CHD的42例患者,根据右心导管检查的平均肺动脉压力(mPAP)是否≥25 mmHg将患者分为CHD+PAH组(26例)和CHD组(16例)。1周内完成CMR检查[右心室收缩末期短轴径(RVESD)、右心室收缩末期容积(RVESV)、右室射血分数(RVEF)、右心室舒张末期心肌质量(RVMMD)]及N末端脑钠肽前体(NT-proBNP)水平检测,进行组间比较,ROC曲线预测对PAH的诊断效能,并与诊断PAH的金标准mPAP、右心室收缩功能金标准RVEF、NT-proBNP行相关性分析。结果与CHD组比较,CHD+PAH组RVESD、RVMMD升高,对PAH具有中度诊断价值(AUC_(1)=0.779,95%CI:0.635~0.923,P<0.01;AUC_(2)=0.784,95%CI:0.646~0.922,P<0.01);相关性分析显示,RVMMD、缺损直径(DD)与mPAP呈正相关(r_(1)=0.470,P<0.01;r_(2)=0.488,P<0.01);RVESVI、右心室收缩末期心肌质量(RVMMS)与RVEF呈负相关(r_(1)=-0.603,P<0.01;r_(2)=-0.595,P<0.01);RVMMS与NTpro-BNP呈正相关(r=0.471,P<0.01)。结论CMR对CHD-PAH具有中等强度的诊断价值,可早期全面监测CHD-PAH患者右心室功能变化。Objective To investigate the diagnostic efficacy of cardiac magnetic resonance(CMR)to left-to-right shunt congenital heart disease(CHD)complicated by pulmonary arterial hypertension(PAH)and review effect of CMR on right ventricular function.Methods The patients with left-to-right shunt CHD(n=42)were chosen from the Affiliated Hospital of Xuzhou Medical University from Sept.2012 to July 2020.According to whether or not mean pulmonary arterial pressure(mPAP)≥25 mmHg examined with right cardiac catheterization,all patients were divided into CHD+PAH group(n=26)and CHD group(n=16).CMR examination was finished within 1 week including right ventricular end-systolic short axis diameter(RVESD),right ventricular end-systolic volume(RVESV),right ventricular ejection fraction(RVEF),right ventricular end-diastolic mass(RVMMD)and plasma brain natriuretic peptide level(NT-proBNP),and results were compared between 2 groups.The diagnostic efficacy of CMR to PAH was predicted by using ROC curve,and a correlation analysis was conducted among mPAP(a gold standard for diagnosing PAH),RVEF(a gold standard for right ventricular systolic function)and NTpro-BNP.Results RVESD and RVMMD increased in CHD+PAH group compared with CHD group,and they had moderate diagnostic value for PAH(AUC_(1)=0.779,95%CI:0.635~0.923,P<0.01;AUC_(2)=0.784,95%CI:0.646~0.922,P<0.01).The results of correlation analysis showed that RVMMD and defect diameter(DD)were positively correlated to mPAP(r_(1)=0.470,P<0.01;r_(2)=0.488,P<0.01),RVESV index and right ventricular end-systolic mass(RVMMS)were negatively correlated to RVEF(r_(1)=-0.603,P<0.01;r_(2)=-0.595,P<0.01),and RVMMS was positively correlated to NTpro-BNP(r=0.471,P<0.01).Conclusion CMR has moderate diagnostic efficacy to CHD complicated by PAH,and can be used for early monitoring the changes of right ventricular function in patients with CHD complicated by PAH.

关 键 词：心脏磁共振 先天性心脏病 肺动脉高压 右心导管术 右心室功能 

分 类 号：R541.1[医药卫生—心血管疾病]