利用实时自由呼吸心血管磁共振成像技术估算静息和运动压力下的肺毛细血管楔压。

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Sören J Backhaus, Alexander Schulz, Torben Lange, Ruben Evertz, Johannes T Kowallick, Gerd Hasenfuß, Andreas Schuster
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引用次数: 0

摘要

背景:右心导管检查(RHC)发现肺毛细血管楔压(PCWP)升高是诊断射血分数保留型心力衰竭(HFpEF)的参考标准。最近,心血管磁共振(CMR)成像估测静息状态下的 PCWP 成为一种无创替代方法。由于许多患者只有在生理运动应激时才会被发现,我们假设新的运动应激CMR得出的PCWP比静息时的评估结果更优:方法:HFpEF-应激试验前瞻性地招募了 75 名患有劳累性呼吸困难和舒张功能障碍的患者,这些患者随后接受了静息和运动应激 RHC 和 CMR 检查。根据 PCWP 对 HFpEF 进行定义(静息时明显 HFpEF ≥15mmHg,运动应激时掩蔽 HFpEF ≥25mmHg)。CMR得出的PCWP是根据之前发表的公式,使用左心室质量(LVM)和双平面左心房容积(LAV)或单平面左心房面积(LAA)计算得出的:结果:LAV(静息/压力:r=0.50/r=0.55,p结论:无创 PCWP 与有创参考值在静息和运动负荷时的相关性良好。尽管绝对值存在偏差,但使用 CMR 推算的 PCWP 评估 HFpEF 总体诊断准确性良好。未来,无创运动得出的 PCWP 可能尤其有助于检测被掩盖的 HFpEF。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rest and exercise-stress estimated pulmonary capillary wedge pressure using real-time free-breathing cardiovascular magnetic resonance imaging.

Background: Identification of increased pulmonary capillary wedge pressure (PCWP) by right heart catheterization (RHC) is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Recently, cardiovascular magnetic resonance (CMR) imaging estimation of PCWP at rest was introduced as a non-invasive alternative. Since many patients are only identified during physiological exercise-stress, we hypothesized that novel exercise-stress CMR-derived PCWP emerges superior compared to its assessment at rest.

Methods: The HFpEF-Stress Trial prospectively recruited 75 patients with exertional dyspnea and diastolic dysfunction who then underwent rest and exercise-stress RHC and CMR. HFpEF was defined according to PCWP (overt HFpEF ≥15 mmHg at rest, masked HFpEF ≥25 mmHg during exercise-stress). CMR-derived PCWP was calculated based on previously published formula using left ventricular mass and either biplane left atrial volume (LAV) or monoplane left atrial area (LAA).

Results: LAV (rest/stress: r = 0.50/r = 0.55, p < 0.001) and LAA PCWP (rest/stress: r = 0.50/r = 0.48, p < 0.001) correlated significantly with RHC-derived PCWP while numerically overestimating PCWP at rest and underestimating PCWP during exercise-stress. LAV and LAA PCWP showed good diagnostic accuracy to detect HFpEF (area under the receiver operating characteristic curve (AUC) LAV rest 0.73, stress 0.81; LAA rest 0.72, stress 0.77) with incremental diagnostic value for the detection of masked HFpEF using exercise-stress (AUC LAV rest 0.54 vs stress 0.67, p = 0.019, LAA rest 0.52 vs stress 0.66, p = 0.012). LAV but not LAA PCWP during exercise-stress was a predictor for 24 months hospitalization independent of a medical history for atrial fibrillation (hazard ratio (HR) 1.26, 95% confidence interval 1.02-1.55, p = 0.032).

Conclusion: Non-invasive PCWP correlates well with the invasive reference at rest and during exercise stress. There is overall good diagnostic accuracy for HFpEF assessment using CMR-derived estimated PCWP despite deviations in absolute agreement. Non-invasive exercise derived PCWP may particularly facilitate detection of masked HFpEF in the future.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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