MRI测量的目标血管面积与慢性血栓栓塞性肺动脉高压血流动力学参数的相关性研究

A correlation study of the cross-sectional area of proximal pulmonary artery and vena cava on MRI with the hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension

目的:探讨MRI测量的肺血管及腔静脉面积与慢性血栓栓塞性肺动脉高压(CTEPH)患者血流动力学参数之间的关系。方法:前瞻性搜集经右心导管检查确诊的慢性血栓栓塞性肺动脉高压患者20例。测量主肺、左右肺动脉、上下腔静脉的平均、最小和最大面积,并与血流动力学参数进行相关性分析。结果:下腔静脉平均、最大面积与肺动脉平均压具有中度相关性(r=0.463、0.447,P=0.040、0.049);下腔静脉平均、最小、最大面积与肺血管阻力指数具有中度相关性(r=0.482、0.444、0.441,P=0.030、0.047、0.049);主肺动脉最小、最大面积(r=0.467、0.468,P=0.044、0.044)及左主肺动脉平均、最小、最大面积(r=0.450、0.468、0.476,P=0.047、0.043、0.039)与右心每博功指数具有中度相关性;左主肺动脉平均、最小、最大面积与右心做功指数具有中度相关性(r=0.473、0.469、0.530,P=0.035、0.043、0.020);上腔静脉平均、最小、最大面积(r=0.516、0.495、0.509,P=0.020、0.031、0.026)及下腔静脉平均、最小、最大面积(r=0.572、0.543、0.445,P=0.008、0.016、0.046)与中心静脉压具有中度相关性。结论:MRI测量的肺动脉及腔静脉面积与CTEPH的血流动力学参数具有中度相关性,而腔静脉面积反映更为全面,对于无创性评估CTEPH患者的病情具有积极意义,并具有潜在的随访应用价值。

Objective：The aim of this study was to explore the correlation of the area of proximal pulmonary artery and vena cava measured on MRI with the hemodynamic parameters in patients with chronic thromboembolie pulmonary hypertension （CTEPH）. Methods：Twenty patients with CTEPH proved by right heart catheterization were prospectively included and underwent MRI. MRI parameters included mean, minimal and maximal area of the main pulmonary artery （MPA） trunk and right/left pulmonary artery （RPA/LPA）. The quantitative data were analyzed by independent samples t-test or Mann-Whitney U test. The correlations were analyzed by Pearson and Spearman correlation coefficient. Results： The Mean and maximal area of inferior vena cava was moderately correlated with mean pulmonary artery pressure （mPAP） （r： 0. 463,0. 447, P ： 0. 040,0. 049, respectively）. The mean, minimal and maximal area of inferior vena cava was moderately correlated with the pulmonary vascular resistance index （PVRI） （r= 0. 482,0. 444,0.441 ; P = 0. 030,0. 047,0. 049, respectively）. Parameters including minimal and maximal area of MPA （r= 0. 467,0. 468 ; P = 0. 044,0. 044, respectively）, mean, minimal and maximal area of LPA （r=0. 450,0. 468,0. 476;P=0. 047,0. 043,0. 039,respectively） had moderate correlations with the right ventricular stroke work index （RVSWI）. The mean,minimal and maximal area of LPA was moderately correlated with right cardiac work index （RCWI） （r 0.473,0.469,0. 530;P=0. 035,0. 043,0. 020,respectively）. The mean, minimal and maximal area of both superior （r= 0. 516,0. 495,0. 509;P= 0. 020,0. 031,0. 026, respectively） and inferio vena cava （r=0. 572,0. 543,0. 445,P=0. 008,0. 016,0. 046,respectively） were moderately correlated with the central venous pressure （CVP）. Conclusions：The size and area of pulmonary artery and vena cava detected by MRI were moderately correlated with hemodynamic parameters, with the vena cava size more effective. We believe these measurements can be used to noninvasively evaluate CTEPH severity and have potential values for follow ups.