国际医学放射学杂志2016，Vol.39Issue(3)：226-230,234,6.DOI:10.19300/j.2016.Z4210
心脏MRI评估肺动脉高压病人严重程度及预后的临床价值
Evaluation of pulmonary arterial hypertension severity and prognosis by using the cardiac magnetic resonance:a clinical study
摘要
Abstract
Objective Pulmonary arterial hypertension (PAH) is a progressive malignant disease and has poor prognosis, ultimately leading to right heart failure and even death if untreated. Early diagnosis is in favor of early intervention to prevent right heart failure. Cardiac magnetic resonance (CMR) imaging has been regarded as an ideal tool to diagnose, assess and monitor patients with PAH non-invasivily. The aim of this study was to further investigate the relationship between CMR parameters and PAH patient severity and prognosis, revealing the important value of CMR in assessing PAH. Methods CMR was performed in 47 PAH patients whose diagnosis had been confirmed with right heart catheterization(RHC) in Tianjin Medical University General Hospital. CMR images were post-processed and the left and right ventricular function parameters were calculated. Patients were followed up until to the occurrence of adverse events. The relationship between baseline CMR and RHC parameters was evaluated with Pearson coefficient, and the follow-up outcome was studied with ROC curves and Cox regression survival analysis. Results At baseline, the CMR measurement have a strong correlation with the mPAP. At follow-up, compared to No Adverse Event Group, the RVEF, TAPSE, and LVSVI were significantly decreased in the Adverse Event Group, while the VMI was significantly increased in the Adverse Event Group (P<0.05). The ROC analysis identified the VMI had the highest AUC value (AUC=0.819) predicting adverse event, with a sensitivity of 69.2%and a specificity of 85.3%.Additionally, the RVEF and TAPSE predicted the adverse event with indentical sensitivity (84.5%). Based on cut-off value of 29.08 mL/m2, the specificity in predicting PAH mortality for LVSVI was 91.2%. According to Kaplan-Meier survival <br> curves, survival was lower in patients with an inframedian RVEF<30.15%, TAPSE<15.8 mm, and LVSVI<29.08 mL/m 2, and a supramedian VMI<0.76. Conclusion RVEF, TAPSE, LVSVI, and VMI assessed with CMR predict outcomes in patients with PAH. A reduced RVEF, TAPSE, LVSVI, and a large VMI are strong predictors of mortality and severity.关键词
磁共振成像/高血压/肺/心室功能,右Key words
Magnetic resonance imaging/Hypertension/Pulmonary/Ventricular function, right引用本文复制引用
王蒙,张璋,杨振文,李东,于铁链,杨帆..心脏MRI评估肺动脉高压病人严重程度及预后的临床价值[J].国际医学放射学杂志,2016,39(3):226-230,234,6.基金项目
国家自然科学基金青年科学基金（81301217），天津市应用基础与前沿技术研究计划重点项目 （）
