心脏MRI评估慢性血栓栓塞性肺动脉高压患者心功能的价值  

Value of cardiac MRI in heart function assessment in patients with chronic thromboembolic pulmonary hypertension

作　　者：赖婷 胡剑锋 成程 邓宇[1] 郭文亮[3] 洪城[3] 雷永霞[1] LAI Ting;HU Jianfeng;CHENG Cheng;DENG Yu;GUO Wenliang;HONG Cheng;Lei Yongxia(Department of Radiology,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Imaging,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510000,China;Department of Respiratory and Critical Care Medicine,First Affiliated Hospital of Guangzhou Medical University,State Key Laboratory of Respiratory Diseases,National Clinical Research Center for Respiratory Diseases,Guangzhou Institute of Respiratory Health,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第一医院放射科,广东广州510000 [2]广东省中医院影像科,广东广州510000 [3]广州医科大学附属第一医院呼吸与危重症医学科呼吸疾病国家重点实验室国家呼吸疾病临床研究中心广州呼吸健康研究院,广东广州510000

出　　处：《广州医科大学学报》2023年第1期17-21,共5页Academic Journal of Guangzhou Medical University

基　　金：2020年广州市卫生健康科技一般引导项目(20201A010051)。

摘　　要：目的:探讨心脏MRI(CMR)评估慢性血栓栓塞性肺动脉高压(CTEPH)患者心室功能的价值。方法:收集广州医科大学附属第一医院经右心导管确诊的33例CTEPH患者(CTEPH组)和39例健康志愿者(对照组)的CMR图像,经CVI42软件分析得到左室(LV)与右室(RV)的舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、射血分数(EF)、舒张末期心肌质量(MM)并计算得到心室质量指数(VMI);除以体表面积(BSA)校正分别得到EDV指数(EDVI)、ESV指数(ESVI)、SV指数(SVI)、MM指数(MMI)。测量获得右室壁厚度(RVWT)、右室面积变化分数(RVFAC)、三尖瓣环收缩期位移(TAPSE),比较两组间心功能参数的差异。结果:CTEPH组LV EDVI、SVI、EF、MMI均低于或显著低于对照组(P<0.05),两组间LV ESVI差异无统计学意义(P>0.05)。CTEPH组RV EDVI、ESVI、MMI及VMI、RVWT均显著高于对照组(P<0.001),RV SVI、EF及RVFAC、TAPSE均显著低于对照组(P<0.01)。结论:CMR能够准确、客观地评估CTEPH患者左右心室形态和功能学改变,对于评估CTEPH患者心室功能具有重要价值。Objective:To investigate the value of cardiac MRI(CMR)in ventricular function assessment in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods:The CMR images from 33 patients with CTEPH diagnosed by right heart catheterization(CTEPH group)in First Affiliated Hospital of Guangzhou Medical University and from 39 healthy volunteers(control group)were retrieved,and subjected to CVI42 software analysis for measurement of the left ventricular(LV)and right ventricular(LV)end⁃diastolic volume(EDV),end⁃systolic volume(ESV),stroke volume(SV),ejection fraction(EF),end⁃diastolic myocardial mass(MM),and the computed ventricular mass index(VMI).These parameters were divided by body surface area(BSA)for adjustment,yielding the values of EDV index(EDVI),ESV index(ESVI),SV index(SVI),and MM index(MMI),respectively.Right ventricular wall thickness(RVWT),fractional area change(RVFAC)and tricuspid annular plane systolic displacement(TAPSE)were measured.The differences in cardiac function parameters between the two groups were compared.Results:The LV⁃EDVI,SVI,EF,and MMI in the CTEPH group were basically or significantly lower than those in the control group(P<0.05),but there was no significant difference in LV⁃ESVI between the two groups(P>0.05).The CTEPH group showed significantly higher RV⁃EDVI,ESVI,MMI,VMI,and RVWT(P<0.001),lower RV⁃SVI,EF,RVFAC,and TAPSE(P<0.01),compared with the control group.Conclusion:CMR may offer accurate and objective evaluation of morphologic and functional alterations of the left and right ventricles in CTEPH patients,and is of great value for ventricular function assessment in this patient subset.

关 键 词：慢性血栓栓塞性肺动脉高压 磁共振成像 心室功能 

分 类 号：R541.5[医药卫生—心血管疾病]