心脏磁共振在肺动脉高压右心室评价中的应用
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摘要
心脏磁共振是评价肺动脉高压患者右心室功能的金标准,对疾病严重程度及预后的判断发挥了重要的作用。心脏磁共振不仅可以对肺动脉高压患者右心室的形态和功能进行定性和定量的评价,还可以对右心室壁的切应力和组织学特征进行评估。现就这些评价方法及其临床价值进行综述。
Cardiac magnetic resonance is the gold standard of the assessment of right ventricle and plays an important role in the evaluation of severity and prognosis in pulmonary artery hypertension patients. Cardiac magnetic resonance can give qualitative and quantitative evaluations in morphology,function,strain and tissue characteristic of right ventricle. This paper reviews these evaluation tools and their clinical value.
Cardiac magnetic resonance is the gold standard of the assessment of right ventricle and plays an important role in the evaluation of severity and prognosis in pulmonary artery hypertension patients. Cardiac magnetic resonance can give qualitative and quantitative evaluations in morphology,function,strain and tissue characteristic of right ventricle. This paper reviews these evaluation tools and their clinical value.
引文
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[2]GalièN,Humbert M,Vachiery JL,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2015,46:903-975.
[3]Sztrymf B,Souza R,Bertoletti L,et al.Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension[J].Eur Respir J,2010,35(6):1286-1293.
[4]Campo A,Mathai SC,le Pavec J,et al.Outcomes of hospitalisation for right heart failure in pulmonary arterial hypertension[J].Eur Respir J,2011,38(2):359-367.
[5]Abraham WT,Adams KF,Fonarow GC,et al.In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications:an analysis from the Acute Decompensated Heart Failure National Registry(ADHERE)[J].J Am Coll Cardiol,2005,46(1):57-64.
[6]Guarracino FCC,Danella A,Doroni L,et al.Right ventricular failure:physiology and assessment[J].Minerva Anestesiol,2005,71(6):307-312.
[7]Ryan JJ,Archer SL.The right ventricle in pulmonary arterial hypertension:disorders of metabolism,angiogenesis and adrenergic signaling in right ventricular failure[J].Circ Res,2014,115(1):176-188.
[8]Bogaard HJ,Natarajan R,Henderson SC,et al.Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure[J].Circulation,2009,120(20):1951-1960.
[9]Vonk Norrdegraaf A,Westerhof BE,Westerhof N.The relationship between the right ventricle and its load in pulmonary hypertension[J].J Am Coll Cardiol,2017,69(2):236-243.
[10]Sano M,Minamino T,Toko H,et al.p53-induced inhibition of Hif-1 causes cardiac dysfunction during pressure overload[J].Nature,2007,446(7134):444-448.
[11]Trip P,Rain S,Handoko ML,et al.Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension[J].Eur Respir J,2015,45(6):1603-1612.
[12]Mona A,Rahul DR,Adriano RT.A review of imaging modalities in pulmonary hypertension[J].Ann Thorac Med,2017,12(2):61-73.
[13]van Wolferen SA,Marcus JT,Boonstra A,et al.Prognostic value of right ventricular mass,volume,and function in idiopathic pulmonary arterial hypertension[J].Eur Heart J,2007,28(10):1250-1257.
[14]Swift AJ,Capener D,Johns C,et al.Magnetic resonance imaging in the prognostic evaluation of patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2017,196(2):228-239.
[15]Stevens GR,Garcia-Alvarez A,Sahni S,et al.RV dysfunction in pulmonary hypertension is independently related to pulmonary artery stiffness[J].JACC Cardiovasc Imaging,2012,5(4):378-387.
[16]Saba TS,Foster J,Cockburn M,et al.Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure[J].Eur Respir J,2002,20(6):1519-1524.
[17]Pena E,Dennie C,Veinot J,et al.Pulmonary hypertension:how the radiologist can help[J].Radiographics,2012,32(1):9-32.
[18]Vonk-Noordegraaf A,Haddad F,Chin KM,et al.Right heart adaptation to pulmonary arterial hypertension:physiology and pathobiology[J].J Am Coll Cardiol,2013,62(25 Suppl):D22-D33.
[19]Shishido M,Hayashi K,Shigemi K,et al.Single-beat estimation of end-systolic elastance using bilinearly approximated time-varying elastance curve[J].Circulation,2000,102(16):1983-1989.
[20]Sanz J,Garcia-Alvarez A,Fernandez-Friera L,et al.Right ventriculo-arterial coupling in pulmonary hypertension:a magnetic resonance study[J].Heart,2012,98(3):238-243.
[21]Truong U,Patel S,Kheyfets V,et al.Non-invasive determination by cardiovascular magnetic resonance of right ventricular-vascular coupling in children and adolescents with pulmonary hypertension[J].J Cardiovasc Magn Reson,2015,17(1):81.
[22]Lin AC,Strugnel WE,Seale H,et al.Exercise cardiac MRI-derived right ventriculo-arterial coupling ratio detects early right ventricular maladaptation in PAH[J].Eur Respir J,2016,48(6):1797-1800.
[23]Vanderpool RR,Pinsky MR,Naeije R,et al.RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension[J].Heart,2015,101(1):37-43.
[24]Augustine D,Lewandowski AJ,Lazdam M,et al.Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers:comparison with tagging and relevance of gender[J].J Cardiovasc Magn Reson,2013,15(1):8.
[25]Tadic M,Cuspidi C,Bomelli M,et al.Right heart remodeling induced by arterial hypertension:could strain assessment be helpful?[J].J Clin Hypertens,2018,20(2):400-407.
[26]Lu KJ,Chen JX,Profitis K,et al.Right ventricular global longitudinal strain is an independent predictor of right ventricular function:a multimodality study of cardiac magnetic resonance imaging,real time three-dimensional echocardiography and speckle tracking echocardiography[J].Echocardiography,2015,32(6):966-974.
[27]D'andrea A,Stanziola A,D'alto M,et al.Right ventricular strain:an independent predictor of survival in idiopathic pulmonary fibrosis[J].Int J Cardiol,2016,222:908-910.
[28]de Siqueira ME,Pozo E,Fernandes VR,et al.Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking[J].J Cardiovasc Magn Reson,2016,18(1):39.
[29]Sachdev A,Villarraga HR,Frantz RP,et al.Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension[J].Chest,2011,139(6):1299-1309.
[30]da Costa Junior AA,Ota-Arakaki JS,Ramos RP,et al.Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance[J].Int J Cardiovasc Imaging,2017,33(1):39-46.
[31]Blyth KG,Groenning BA,Martin TN,et al.Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension[J].Eur Heart J,2005,26(19):1993-1999.
[32]van Oorschot JW,Gho JM,van Hout GP,et al.Endogenous contrast MRI of cardiac fibrosis:beyond late gadolinium enhancement[J].J Magn Reson Imaging,2015,41(5):1181-1189.
[33]Spruijt OA,Vissers L,Bogaard HJ,et al.Increased native T1-values at the interventricular insertion regions in precapillary pulmonary hypertension[J].Int JCardiovasc Imaging,2016,32(3):451-459.
[34]Chen YY,Yun H,Jin H,et al.Association of native T1 times with biventricular function and hemodynamics in precapillary pulmonary hypertension[J].Int JCardiovasc Imaging,2017,33(8):1179-1189.
[35]Roller FC,Wiedenroth C,Breithecker A,et al.Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension[J].Eur Radiol,2017,27(5):1980-1991.
[2]GalièN,Humbert M,Vachiery JL,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2015,46:903-975.
[3]Sztrymf B,Souza R,Bertoletti L,et al.Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension[J].Eur Respir J,2010,35(6):1286-1293.
[4]Campo A,Mathai SC,le Pavec J,et al.Outcomes of hospitalisation for right heart failure in pulmonary arterial hypertension[J].Eur Respir J,2011,38(2):359-367.
[5]Abraham WT,Adams KF,Fonarow GC,et al.In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications:an analysis from the Acute Decompensated Heart Failure National Registry(ADHERE)[J].J Am Coll Cardiol,2005,46(1):57-64.
[6]Guarracino FCC,Danella A,Doroni L,et al.Right ventricular failure:physiology and assessment[J].Minerva Anestesiol,2005,71(6):307-312.
[7]Ryan JJ,Archer SL.The right ventricle in pulmonary arterial hypertension:disorders of metabolism,angiogenesis and adrenergic signaling in right ventricular failure[J].Circ Res,2014,115(1):176-188.
[8]Bogaard HJ,Natarajan R,Henderson SC,et al.Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure[J].Circulation,2009,120(20):1951-1960.
[9]Vonk Norrdegraaf A,Westerhof BE,Westerhof N.The relationship between the right ventricle and its load in pulmonary hypertension[J].J Am Coll Cardiol,2017,69(2):236-243.
[10]Sano M,Minamino T,Toko H,et al.p53-induced inhibition of Hif-1 causes cardiac dysfunction during pressure overload[J].Nature,2007,446(7134):444-448.
[11]Trip P,Rain S,Handoko ML,et al.Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension[J].Eur Respir J,2015,45(6):1603-1612.
[12]Mona A,Rahul DR,Adriano RT.A review of imaging modalities in pulmonary hypertension[J].Ann Thorac Med,2017,12(2):61-73.
[13]van Wolferen SA,Marcus JT,Boonstra A,et al.Prognostic value of right ventricular mass,volume,and function in idiopathic pulmonary arterial hypertension[J].Eur Heart J,2007,28(10):1250-1257.
[14]Swift AJ,Capener D,Johns C,et al.Magnetic resonance imaging in the prognostic evaluation of patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2017,196(2):228-239.
[15]Stevens GR,Garcia-Alvarez A,Sahni S,et al.RV dysfunction in pulmonary hypertension is independently related to pulmonary artery stiffness[J].JACC Cardiovasc Imaging,2012,5(4):378-387.
[16]Saba TS,Foster J,Cockburn M,et al.Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure[J].Eur Respir J,2002,20(6):1519-1524.
[17]Pena E,Dennie C,Veinot J,et al.Pulmonary hypertension:how the radiologist can help[J].Radiographics,2012,32(1):9-32.
[18]Vonk-Noordegraaf A,Haddad F,Chin KM,et al.Right heart adaptation to pulmonary arterial hypertension:physiology and pathobiology[J].J Am Coll Cardiol,2013,62(25 Suppl):D22-D33.
[19]Shishido M,Hayashi K,Shigemi K,et al.Single-beat estimation of end-systolic elastance using bilinearly approximated time-varying elastance curve[J].Circulation,2000,102(16):1983-1989.
[20]Sanz J,Garcia-Alvarez A,Fernandez-Friera L,et al.Right ventriculo-arterial coupling in pulmonary hypertension:a magnetic resonance study[J].Heart,2012,98(3):238-243.
[21]Truong U,Patel S,Kheyfets V,et al.Non-invasive determination by cardiovascular magnetic resonance of right ventricular-vascular coupling in children and adolescents with pulmonary hypertension[J].J Cardiovasc Magn Reson,2015,17(1):81.
[22]Lin AC,Strugnel WE,Seale H,et al.Exercise cardiac MRI-derived right ventriculo-arterial coupling ratio detects early right ventricular maladaptation in PAH[J].Eur Respir J,2016,48(6):1797-1800.
[23]Vanderpool RR,Pinsky MR,Naeije R,et al.RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension[J].Heart,2015,101(1):37-43.
[24]Augustine D,Lewandowski AJ,Lazdam M,et al.Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers:comparison with tagging and relevance of gender[J].J Cardiovasc Magn Reson,2013,15(1):8.
[25]Tadic M,Cuspidi C,Bomelli M,et al.Right heart remodeling induced by arterial hypertension:could strain assessment be helpful?[J].J Clin Hypertens,2018,20(2):400-407.
[26]Lu KJ,Chen JX,Profitis K,et al.Right ventricular global longitudinal strain is an independent predictor of right ventricular function:a multimodality study of cardiac magnetic resonance imaging,real time three-dimensional echocardiography and speckle tracking echocardiography[J].Echocardiography,2015,32(6):966-974.
[27]D'andrea A,Stanziola A,D'alto M,et al.Right ventricular strain:an independent predictor of survival in idiopathic pulmonary fibrosis[J].Int J Cardiol,2016,222:908-910.
[28]de Siqueira ME,Pozo E,Fernandes VR,et al.Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking[J].J Cardiovasc Magn Reson,2016,18(1):39.
[29]Sachdev A,Villarraga HR,Frantz RP,et al.Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension[J].Chest,2011,139(6):1299-1309.
[30]da Costa Junior AA,Ota-Arakaki JS,Ramos RP,et al.Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance[J].Int J Cardiovasc Imaging,2017,33(1):39-46.
[31]Blyth KG,Groenning BA,Martin TN,et al.Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension[J].Eur Heart J,2005,26(19):1993-1999.
[32]van Oorschot JW,Gho JM,van Hout GP,et al.Endogenous contrast MRI of cardiac fibrosis:beyond late gadolinium enhancement[J].J Magn Reson Imaging,2015,41(5):1181-1189.
[33]Spruijt OA,Vissers L,Bogaard HJ,et al.Increased native T1-values at the interventricular insertion regions in precapillary pulmonary hypertension[J].Int JCardiovasc Imaging,2016,32(3):451-459.
[34]Chen YY,Yun H,Jin H,et al.Association of native T1 times with biventricular function and hemodynamics in precapillary pulmonary hypertension[J].Int JCardiovasc Imaging,2017,33(8):1179-1189.
[35]Roller FC,Wiedenroth C,Breithecker A,et al.Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension[J].Eur Radiol,2017,27(5):1980-1991.