基于心脏磁共振右心室-肺动脉耦联参数在评估CTD-PH危险分层中的研究  

The study of CMR based right ventricular-pulmonary arterial coupling in the assessment of CTD-PH risk stratification

作　　者：马珂凡 刘王琰 王嫱[2] 孙晓萱[2] 祝因苏[1] 徐怡[1] MA Kefan;LIU Wangyan;WANG Qiang;SUN Xiaoxuan;ZHU Yinsu;XU Yi(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Rheumatology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京医科大学第一附属医院风湿科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2023年第8期1121-1127,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81601464,61871117)。

摘　　要：目的:探讨基于心脏磁共振(CMR)右心室-肺动脉耦联(VAC)参数在评估结缔组织疾病相关肺动脉高压(CTD-PH)危险分层中的应用价值。方法:回顾性分析2018年6月—2022年4月期间62例CTD-PH患者临床及CMR资料,根据危险分层将其分为组1(低危及中低危患者,n=39例)和组2(中高危及高危患者,n=23例),并对患者的左右心室容积、功能参数、左心室心肌组织学参数及VAC进行分析,寻找用于预测CTD-PH危险分层的最佳模型。结果:右心室容积功能参数和右心室插入部的组织学参数在两组PH患者间的差异有统计学意义(P<0.05)。右心室舒张末期容积指数(RVEDVI)和VAC具有独立预测效能,联合RVEDVI和VAC具有最高的预测准确性(AUC=0.839,95%CI:0.735~0.944,P<0.001)。结论:右心室相关的容积、功能参数和右心室插入部的组织学参数可用于评估CTD-PH危险分层,联合RVEDVI和VAC可提高评估危险分层的准确性。Objective:To investigate the value of cardiac magnetic resonance(CMR)based right ventricular-pulmonary arterial coupling(VAC)parameters in assessing risk stratification of connective tissue disease-related pulmonary hypertension(CTD-PH).Methods:The clinical and CMR data of 62 patients with CTD-PH between June 2018 and April 2022 were retrospectively analyzed,and they were divided into group 1(low-risk and low-to-moderate-risk patients,n=39)and group 2(moderate-to-high-risk and high-risk patients,n=23)according to risk stratification,and the patients’right and left ventricle-related volumetric and functional parameters,left ventricular tissue characterization parameters and VAC were statistically analyzed.The optimal model was sought to predict CTD-PH risk stratification.Results:The differences in right ventricle-related volumetric and functional parameters,and tissue characterization parameters of the right ventricular insertion were statistically significant in the two groups of patients with CTD-PH(P<0.05).The right ventricular end-diastolic point(RVIP)volume index(RVEDVI)and VAC were independent predictors,and the combination of RVEDVI and VAC had the best predictive accuracy(AUC=0.839,95%CI:0.735~0.944,P<0.001).Conclusion:Right ventricle-related volumetric and functional parameters,and RVIP tissue characterization parameters can be used to assess CTD-PH risk stratification;the combination of RVEDVI and VAC improves the accuracy of assessing risk stratification.

关 键 词：右心室-肺动脉耦联 右心室功能 肺动脉高压 心脏磁共振 

分 类 号：R445.2[医药卫生—影像医学与核医学]