不同右心室-肺动脉耦合方法评估肺动脉高压患者右心室功能研究

Different right ventricular-pulmonary artery coupling methods was used to evaluate the function of right ventricular in patients with pulmonary artery hypertension

目的 比较单次心跳法、压力-容积环法以及结合心脏核磁共振(cardiac magnetic resonance imaging,CMR)技术的容积法检测肺动脉高压患者右心室-肺动脉耦合(Ees/Ea)比值的准确性,为临床找到一个切实有效、定量评估肺动脉高压患者右心室功能的方法.方法 回顾性纳入2015年5月至2017年5月期间在武汉亚洲心脏病医院诊疗的49例肺动脉高压患者,分别用单次心跳法、结合CMR技术的容积法以及压力-容积环法测得Ees/Ea比值,再与NYHA心功能分级及NT-proBNP值比较,评估三种方法定量评价右心功能的准确性.结果 ①单次心跳法测量的Ees/Ea为2.07±1.01,与NYHA心功能分级及NT-proBNP相关性分析均未见统计学差异(P>0.05).②压力-容积环法测得的Ees/Ea为2.64±1.48,与NYHA心功能分级及NT-proBNP相关性分析均未见统计学差异(P>0.05).③结合CMR技术的容积法测得的Ees/Ea为0.72±0.43,与NYHA心功能分级及NT-proBNP相关性分析均具有统计学意义(P<0.05),均呈负相关,即随着NT-proBNP的增高,Ees/Ea随之降低;随着NYHA心功能分级的递增Ees/Ea也随之降低.④结合CMR技术的容积法Ees/Ea与log(NT-proBNP)之间建立了线性回归方程:Y=-0.257X+1.45,且回归方程具有统计学意义(P=0.001).结论 结合CMR技术的容积法获得的Ees/Ea是一种具有临床可靠且无创的定量评估肺动脉高压患者右心功能的可行性方法.

Objective To compare the accuracy of Ees/Ea ratio measured by single beat estimation, Pressure-Volume Loop and CMR combined volume method in patients with pulmonary artery hypertension,and to find a feasible and reliable method to quantitatively evaluate the function of right ventricular in patients with pulmonary artery hypertension.Methods 49pulmonary artery hypertension patients collected from May 2017to May 2018in our hospital were retrospectively analyzed.Single heartbeat method,pressure-volume ring method and combined with CMR technology volume method were measured Ees/Ea ratio,and then compared with NYHA heart function classification and NT-proBNP value respectively,and to evaluate the accuracy of the three methods.Results (1)The Ees/Ea ratio measured by single beat estimation was 2.07±1.01but the correlation analysis was not statistically significant when compared with NYHA classification and NT-proBNP value (P> 0.05).(2)The Ees/Ea ratio measured by Pressure-Volume Loop was 2.64±1.48yet the correlation analysis was not statistically significant when compared with NYHA classification and NT-proBNP value (P>0.05).(3)The Ees/Ea ratio measured by CMR combined volume method was 0.72±0.43and the correlation analysis was statistically significant when compared with NYHA classification and NT-proBNP with the negative correlation (P<0.05).The Ees/Ea ratio decreased with the increase of NT-proBNP value and the NYHA classification.(4)There was a linear regression equation between the Ees/Ea ratio measured by CMR combined volume method and log(NT-proBNP) value:Y=-0.257X+1.45;and the linear regression equation was statistically significant (P=0.001).Conclusion The Ees/Ea ratio measured by CMR combined volume method is a feasible and reliable method to quantitatively evaluate the function of right ventricular in patients with pulmonary artery hypertension.