心脏磁共振评价肺性高血压的临床应用与研究进展
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摘要
肺高血压(PH)预后较差,对PH早期确诊、病因分类、合理干预及密切随访可防止右心衰竭,挽救患者生命。心脏核磁共振(CMR)在评估心脏形态结构、功能等方面具有独特的优势,已成为临床诊断和监测PH的重要影像学手段。本文旨在综述CMR在评估PH方面的具体临床应用及研究进展。
Pulmonary hypertension(PH) is a progressive disorder characterized by abnormally elevated blood pressureof the pulmonary circulation.PH progresses rapidly to right ventricular(RV) failure and even death without treatment.Cardiac magnetic resonance(CMR) is an accurate and reproducible tool for the assessment of RV morphology and function,which plays an important role in the prognosis of patients with PH.The aim of this study is to review the clinical applicationand research progress of CMR in evaluation of PH.
Pulmonary hypertension(PH) is a progressive disorder characterized by abnormally elevated blood pressureof the pulmonary circulation.PH progresses rapidly to right ventricular(RV) failure and even death without treatment.Cardiac magnetic resonance(CMR) is an accurate and reproducible tool for the assessment of RV morphology and function,which plays an important role in the prognosis of patients with PH.The aim of this study is to review the clinical applicationand research progress of CMR in evaluation of PH.
引文
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[6]Yang T,Liang Y,Zhang Y,et al.Echocardiographic parameters inpatients with pulmonary arterial hypertension:Correlations withright ventricular ejection fraction derived from cardiac magneticresonance and hemodynamics[J].PLo S One,2013,8(8):e71276.doi:10.1371/journal.pone.0071276.
[7]Schiebler ML,Bhalla S,Runo J,et al.Magnetic resonance andcomputed tomography imaging of the structural and functionalchanges of pulmonary arterial hypertension[J].J Thorac Imaging,2013,28(3):178-193.doi:10.1097/RTI.0b013e31828d5c48.
[8]Truong U,Patel S,Kheyfets V,et al.Non-invasive determination bycardiovascular magnetic resonance of right ventricular-vascularcoupling in children and adolescents with pulmonary hypertension[J].J Cardiovasc Magn Reson,2015,17(1):81.doi:10.1186/s12968-015-0186-1.
[9]Ibrahim el-SH,Bajwa AA.Severe pulmonary arterial hypertension:comprehensive evaluation by magnetic resonance imaging[J].CaseRep Radiol,2015,2015:946920.doi:10.1155/2015/946920.
[10]Swift AJ,Wild JM,Nagle SK,et al.Quantitative magneticresonance imaging of pulmonary hypertension:a practical approachto the current state of the art[J].J Thorac Imaging,2014,29(2):68-79.doi:10.1097/RTI.0000000000000079.
[11]Swift AJ,Rajaram S,Marshall H,et al.Black blood MRI hasdiagnostic and prognostic value in the assessment of patients withpulmonary hypertension[J].Eur Radiol,2012,22(3):695-702.doi:10.1007/s00330-011-2306-0.
[12]Shehata ML,Harouni AA,Skrok J,et al.Regional and globalbiventricular function in pulmonary arterial hypertension:a cardiacMR imaging study[J].Radiology,2013,266(1):114-122.doi:10.1148/radiol.12111599.
[13]Rain S,Handoko ML,Trip P,et al.Right ventricular diastolicimpairment in patients with pulmonary arterial hypertension[J].Circulation,2013,128(18):2016-2025,2011-2010.doi:10.1161/CIRCULATIONAHA.113.001873.
[14]Doesch C,Zompolou C,Streitner F,et al.Cmr-derived tapsemeasurement:a semi-quantitative method of right ventricular functionassessment in patients with hypertrophic cardiomyopathy[J].NethHeart J,2014,22(12):557-564.doi:10.1007/s12471-014-0601-5.
[15]Saba TS,Foster J,Cockburn M,et al.Ventricular mass index usingmagnetic resonance imaging accurately estimates pulmonary arterypressure[J].Eur Respir J,2002,20(6):1519-1524.
[16]Yamada Y,Okuda S,Kataoka M,et al.Prognostic value of cardiac magnetic resonance imaging for idiopathic pulmonary arterialhypertension before initiating intravenous prostacyclin therapy[J].Circ J,2012,76(7):1737-1743.doi:JST.JSTAGE/circj/CJ-11-1237[pii].
[17]Pandya B,Quail MA,Steeden JA,et al.Real-time magneticresonance assessment of septal curvature accurately tracks acutehemodynamic changes in pediatric pulmonary hypertension[J].Circ Cardiovasc Imaging,2014,7(4):706-713.doi:10.1161/CIRCIMAGING.113.001156.
[18]Dellegrottaglie S,Sanz J,Poon M,et al.Pulmonary hypertension:accuracy of detection with left ventricular septal-to-free wallcurvature ratio measured at cardiac MR[J].Radiology,2007,243(1):63-69.doi:243/1/63[pii].
[19]Raymond TE,Khabbaza JE,Yadav R,et al.Significance of mainpulmonary artery dilation on imaging studies[J].Ann Am Thorac Soc,2014,11(10):1623-1632.doi:10.1513/Annals ATS.201406-253PP.
[20]Haddad F,Guihaire J,Skhiri M,et al.Septal curvature is marker ofhemodynamic,anatomical,and electromechanical ventricularinterdependence in patients with pulmonary arterial hypertension[J].Echocardiography,2014,31(6):699-707.doi:10.1111/echo.12468.
[21]Sanz J,Kuschnir P,Rius T,et al.Pulmonary arterial hypertension:noninvasive detection with phase-contrast MR imaging[J].Radiology,2007,243(1):70-79.doi:2431060477[pii].
[22]Swift AJ,Rajaram S,Hurdman J,et al.Noninvasive estimation of papressure,flow,and resistance with cmr imaging:derivation andprospective validation study from the aspire registry[J].JACCCardiovasc Imaging,2013,6(10):1036-1047.doi:10.1016/j.jcmg.2013.01.013.
[23]Forouzan O,Warczytowa J,Wieben O,et al.Non-invasivemeasurement using cardiovascular magnetic resonance of changesin pulmonary artery stiffness with exercise[J].J Cardiovasc MagnReson,2015,17:109.doi:10.1186/s12968-015-0213-2.
[24]Terada M,Takehara Y,Isoda H,et al.Low WSS and high OSImeasured by 3D cine PC MRI reflect high pulmonary arterypressures in suspected secondary pulmonary arterial hypertension[J].Magn Reson Med Sci,2016,15(2):193-202.doi:10.2463/mrms.mp.2015-0038.
[25]Junqueira FP,Lima CM,Coutinho AC Jr,et al.Pulmonary arterialhypertension:an imaging review comparing MR pulmonary angiographyand perfusion with multidetector CT angiography[J].Br J Radiol,2012,85(1019):1446-1456.doi:10.1259/bjr/28150079.
[26]Saggar R,Sitbon O.Hemodynamics in pulmonary arterialhypertension:current and future perspectives[J].Am J Cardiol,2012,110(6 Suppl):9S-15S.doi:10.1016/j.amjcard.2012.06.011.
[27]Vogel-Claussen J,Skrok J,Shehata ML,et al.Right and leftventricular myocardial perfusion reserves correlate with rightventricular function and pulmonary hemodynamics in patients withpulmonary arterial hypertension[J].Radiology,2011,258(1):119-127.doi:10.1148/radiol.10100725.
[28]Shehata ML,Lossnitzer D,Skrok J,et al.Myocardial delayedenhancement in pulmonary hypertension:pulmonary hemodynamics,right ventricular function,and remodeling[J].AJR Am J Roentgenol,2011,196(1):87-94.doi:10.2214/AJR.09.4114.
[29]Bessa LG,Junqueira FP,Bandeira ML,et al.Pulmonary arterialhypertension:use of delayed contrast-enhanced cardiovascular magnetic resonance in risk assessmen[tJ].Arq Bras Cardiol,2013,101(4):336-343.doi:10.5935/abc.20130168.
[30]Swift AJ,Rajaram S,Capener D,et al.Lge patterns in pulmonaryhypertension do not impact overall mortality[J].JACC CardiovascImaging,2014,7(12):1209-1217.doi:10.1016/j.jcmg.2014.08.014.
[31]Swift AJ,Rajaram S,Campbell MJ,et al.Prognostic value ofcardiovascular magnetic resonance imaging measurements correctedfor age and sex in idiopathic pulmonary arterial hypertension[J].CircCardiovasc Imaging,2014,7(1):100-106.doi:10.1161/CIRCIMAGING.113.000338.
[32]Lungu A,Wild JM,Capener D,et al.MRI model-based non-invasivedifferential diagnosis in pulmonary hypertension[J].J Biomech,2014,47(12):2941-2947.doi:10.1016/j.jbiomech.2014.07.024.
[33]Corona-Villalobos CP,Kamel IR,Rastegar N,et al.Bidimensionalmeasurements of right ventricular function for prediction of survival in patients with pulmonary hypertension:comparison of reproducibilityand time of analysis with volumetric cardiac magnetic resonanceimaging analysis[J].Pulm Circ,2015,5(3):527-537.doi:10.1086/682229.
[34]Park YM,Chung WJ,Choi DY,et al.Functional class and targetedtherapy are related to the survival in patients with pulmonaryarterial hypertension[J].Yonsei Med J,2014,55(6):1526-1532.doi:10.3349/ymj.2014.55.6.1526.
[35]Moledina S,Pandya B,Bartsota M,et al.Prognostic significance ofcardiac magnetic resonance imaging in children with pulmonaryhypertension[J].Circ Cardiovasc Imaging,2013,6(3):407-414.doi:10.1161/CIRCIMAGING.112.000082.2016-02-02 2016-02-16
[2]Badagliacca R,Poscia R,Pezzuto B,et al.Right ventricularremodeling in idiopathic pulmonary arterial hypertension:Adaptiveversus maladaptive morphology[J].J Heart Lung Transplant,2015,34(3):395-403.doi:10.1016/j.healun.2014.11.002.
[3]Peacock AJ,Crawley S,Mc Lure L,et al.Changes in rightventricular function measured by cardiac magnetic resonanceimaging in patients receiving pulmonary arterial hypertension-targeted therapy:the euro-mr study[J].Circ Cardiovasc Imaging,2014,7(1):107-114.doi:10.1161/CIRCIMAGING.113.000629.
[4]Addetia K,Bhave NM,Tabit CE,et al.Sample size and costanalysis for pulmonary arterial hypertension drug trials usingvarious imaging modalities to assess right ventricular size andfunction end points[J].Circ Cardiovasc Imaging,2014,7(1):115-124.doi:10.1161/CIRCIMAGING.113.000932.
[5]Tio D,Leter E,Boerrigter B,et al.Risk factors for hemoptysis inidiopathic and hereditary pulmonary arterial hypertension[J].PLo SOne,2013,8(10):e78132.doi:10.1371/journal.pone.0078132.
[6]Yang T,Liang Y,Zhang Y,et al.Echocardiographic parameters inpatients with pulmonary arterial hypertension:Correlations withright ventricular ejection fraction derived from cardiac magneticresonance and hemodynamics[J].PLo S One,2013,8(8):e71276.doi:10.1371/journal.pone.0071276.
[7]Schiebler ML,Bhalla S,Runo J,et al.Magnetic resonance andcomputed tomography imaging of the structural and functionalchanges of pulmonary arterial hypertension[J].J Thorac Imaging,2013,28(3):178-193.doi:10.1097/RTI.0b013e31828d5c48.
[8]Truong U,Patel S,Kheyfets V,et al.Non-invasive determination bycardiovascular magnetic resonance of right ventricular-vascularcoupling in children and adolescents with pulmonary hypertension[J].J Cardiovasc Magn Reson,2015,17(1):81.doi:10.1186/s12968-015-0186-1.
[9]Ibrahim el-SH,Bajwa AA.Severe pulmonary arterial hypertension:comprehensive evaluation by magnetic resonance imaging[J].CaseRep Radiol,2015,2015:946920.doi:10.1155/2015/946920.
[10]Swift AJ,Wild JM,Nagle SK,et al.Quantitative magneticresonance imaging of pulmonary hypertension:a practical approachto the current state of the art[J].J Thorac Imaging,2014,29(2):68-79.doi:10.1097/RTI.0000000000000079.
[11]Swift AJ,Rajaram S,Marshall H,et al.Black blood MRI hasdiagnostic and prognostic value in the assessment of patients withpulmonary hypertension[J].Eur Radiol,2012,22(3):695-702.doi:10.1007/s00330-011-2306-0.
[12]Shehata ML,Harouni AA,Skrok J,et al.Regional and globalbiventricular function in pulmonary arterial hypertension:a cardiacMR imaging study[J].Radiology,2013,266(1):114-122.doi:10.1148/radiol.12111599.
[13]Rain S,Handoko ML,Trip P,et al.Right ventricular diastolicimpairment in patients with pulmonary arterial hypertension[J].Circulation,2013,128(18):2016-2025,2011-2010.doi:10.1161/CIRCULATIONAHA.113.001873.
[14]Doesch C,Zompolou C,Streitner F,et al.Cmr-derived tapsemeasurement:a semi-quantitative method of right ventricular functionassessment in patients with hypertrophic cardiomyopathy[J].NethHeart J,2014,22(12):557-564.doi:10.1007/s12471-014-0601-5.
[15]Saba TS,Foster J,Cockburn M,et al.Ventricular mass index usingmagnetic resonance imaging accurately estimates pulmonary arterypressure[J].Eur Respir J,2002,20(6):1519-1524.
[16]Yamada Y,Okuda S,Kataoka M,et al.Prognostic value of cardiac magnetic resonance imaging for idiopathic pulmonary arterialhypertension before initiating intravenous prostacyclin therapy[J].Circ J,2012,76(7):1737-1743.doi:JST.JSTAGE/circj/CJ-11-1237[pii].
[17]Pandya B,Quail MA,Steeden JA,et al.Real-time magneticresonance assessment of septal curvature accurately tracks acutehemodynamic changes in pediatric pulmonary hypertension[J].Circ Cardiovasc Imaging,2014,7(4):706-713.doi:10.1161/CIRCIMAGING.113.001156.
[18]Dellegrottaglie S,Sanz J,Poon M,et al.Pulmonary hypertension:accuracy of detection with left ventricular septal-to-free wallcurvature ratio measured at cardiac MR[J].Radiology,2007,243(1):63-69.doi:243/1/63[pii].
[19]Raymond TE,Khabbaza JE,Yadav R,et al.Significance of mainpulmonary artery dilation on imaging studies[J].Ann Am Thorac Soc,2014,11(10):1623-1632.doi:10.1513/Annals ATS.201406-253PP.
[20]Haddad F,Guihaire J,Skhiri M,et al.Septal curvature is marker ofhemodynamic,anatomical,and electromechanical ventricularinterdependence in patients with pulmonary arterial hypertension[J].Echocardiography,2014,31(6):699-707.doi:10.1111/echo.12468.
[21]Sanz J,Kuschnir P,Rius T,et al.Pulmonary arterial hypertension:noninvasive detection with phase-contrast MR imaging[J].Radiology,2007,243(1):70-79.doi:2431060477[pii].
[22]Swift AJ,Rajaram S,Hurdman J,et al.Noninvasive estimation of papressure,flow,and resistance with cmr imaging:derivation andprospective validation study from the aspire registry[J].JACCCardiovasc Imaging,2013,6(10):1036-1047.doi:10.1016/j.jcmg.2013.01.013.
[23]Forouzan O,Warczytowa J,Wieben O,et al.Non-invasivemeasurement using cardiovascular magnetic resonance of changesin pulmonary artery stiffness with exercise[J].J Cardiovasc MagnReson,2015,17:109.doi:10.1186/s12968-015-0213-2.
[24]Terada M,Takehara Y,Isoda H,et al.Low WSS and high OSImeasured by 3D cine PC MRI reflect high pulmonary arterypressures in suspected secondary pulmonary arterial hypertension[J].Magn Reson Med Sci,2016,15(2):193-202.doi:10.2463/mrms.mp.2015-0038.
[25]Junqueira FP,Lima CM,Coutinho AC Jr,et al.Pulmonary arterialhypertension:an imaging review comparing MR pulmonary angiographyand perfusion with multidetector CT angiography[J].Br J Radiol,2012,85(1019):1446-1456.doi:10.1259/bjr/28150079.
[26]Saggar R,Sitbon O.Hemodynamics in pulmonary arterialhypertension:current and future perspectives[J].Am J Cardiol,2012,110(6 Suppl):9S-15S.doi:10.1016/j.amjcard.2012.06.011.
[27]Vogel-Claussen J,Skrok J,Shehata ML,et al.Right and leftventricular myocardial perfusion reserves correlate with rightventricular function and pulmonary hemodynamics in patients withpulmonary arterial hypertension[J].Radiology,2011,258(1):119-127.doi:10.1148/radiol.10100725.
[28]Shehata ML,Lossnitzer D,Skrok J,et al.Myocardial delayedenhancement in pulmonary hypertension:pulmonary hemodynamics,right ventricular function,and remodeling[J].AJR Am J Roentgenol,2011,196(1):87-94.doi:10.2214/AJR.09.4114.
[29]Bessa LG,Junqueira FP,Bandeira ML,et al.Pulmonary arterialhypertension:use of delayed contrast-enhanced cardiovascular magnetic resonance in risk assessmen[tJ].Arq Bras Cardiol,2013,101(4):336-343.doi:10.5935/abc.20130168.
[30]Swift AJ,Rajaram S,Capener D,et al.Lge patterns in pulmonaryhypertension do not impact overall mortality[J].JACC CardiovascImaging,2014,7(12):1209-1217.doi:10.1016/j.jcmg.2014.08.014.
[31]Swift AJ,Rajaram S,Campbell MJ,et al.Prognostic value ofcardiovascular magnetic resonance imaging measurements correctedfor age and sex in idiopathic pulmonary arterial hypertension[J].CircCardiovasc Imaging,2014,7(1):100-106.doi:10.1161/CIRCIMAGING.113.000338.
[32]Lungu A,Wild JM,Capener D,et al.MRI model-based non-invasivedifferential diagnosis in pulmonary hypertension[J].J Biomech,2014,47(12):2941-2947.doi:10.1016/j.jbiomech.2014.07.024.
[33]Corona-Villalobos CP,Kamel IR,Rastegar N,et al.Bidimensionalmeasurements of right ventricular function for prediction of survival in patients with pulmonary hypertension:comparison of reproducibilityand time of analysis with volumetric cardiac magnetic resonanceimaging analysis[J].Pulm Circ,2015,5(3):527-537.doi:10.1086/682229.
[34]Park YM,Chung WJ,Choi DY,et al.Functional class and targetedtherapy are related to the survival in patients with pulmonaryarterial hypertension[J].Yonsei Med J,2014,55(6):1526-1532.doi:10.3349/ymj.2014.55.6.1526.
[35]Moledina S,Pandya B,Bartsota M,et al.Prognostic significance ofcardiac magnetic resonance imaging in children with pulmonaryhypertension[J].Circ Cardiovasc Imaging,2013,6(3):407-414.doi:10.1161/CIRCIMAGING.112.000082.2016-02-02 2016-02-16