心脏磁共振心功能指标评估肺动脉高压患者预后的价值

Prognosis value of cardiac magnetic resonance cardiac function index in patients with pulmonary hypertension

目的探讨心脏磁共振(CMR)成像指标与肺动脉高压(PH)患者预后的关系。方法纳入我院经右心导管插入确诊并行CMR检查的PH患者90例,分析其CMR图像并计算心功能指标:右心室和左心室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、每搏输出量指数(SVI)、射血分数(EF),以及右房室瓣环收缩期位移(TAPSE)。随访终点为发生主要心血管不良事件(MACE)。采用两独立样本t检验对发生MACE患者(MACE组)与未发生MACE患者(non-MACE组)的CMR指标进行比较。采用Cox比例风险回归模型分析终点事件的独立预测因素,根据受试者工作特征(ROC)曲线获得的最佳截断值绘制Kaplan-Meier生存曲线。结果与non-MACE组相比,MACE组患者右心室EF、左心室SVI、TAPSE均降低[(27.00±9.92)%vs(32.68±11.34)%、(29.14±8.73)m L/m2 vs(35.41±11.59)m L/m2、(12.51±4.17)mm vs(16.04±7.37)mm],右心室EDVI和ESVI均升高[(139.72±48.70)mL/m2vs(116.07±44.79)mL/m2、(104.26±42.88)mL/m2vs(79.37±35.67)mL/m2],差异均有统计学意义(t=-2.065、-2.286、-2.089、2.076、2.668,P均<0.05)。多因素分析结果显示,左心室SVI、TAPSE是PH患者发生MACE的独立预测因素[风险比(HR)=0.942、0.904,P=0.039、0.022]。ROC曲线确定的左心室SVI、TAPSE的最佳截断值分别为30.27 mL/m2、15.65 mm,Kaplan-Meier生存分析结果示当LVSVI≤30.27 mL/m2、TAPSE≤15.65 mm时MACE发生率增加(P=0.001、0.019)。结论发生MACE的PH患者左心、右心功能均较差,TAPSE、左心室SVI可作为PH患者发生MACE的独立预测因素。

Objective To explore the effect of cardiac magnetic resonance (CMR) imaging parameters on prognosis of the patients with pulmonary hypertension (PH). Methods Ninety PH patients, who were diagnosed by right heart catheterization and received CMR examination in our hospital, were enrolled for this study. The cardiac functional parameters, including end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI) and ejection fraction (EF) of the right ventricle and left ventricle, and tricuspid annular plane systolic excursion (TAPSE), were analyzed. The study end-point was major adverse cardiovascular event (MACE). Two independent sample t test was used to analyze the differences of CMR parameters between MACE group and non-MACE group. Cox proportional hazards regression model was used to determine the independent predictors of end-point events. Kaplan-Meier survival curve was drawn based on the optimal cut-off value of receiver operating characteristic (ROC) curve. Results Compared with the non-MACE group, the right ventricular EF, left ventricular SVI and TAPSE were decreased in the MACE group ([27.00±9.92]% vs [32.68±11.34]%,[29.14±8.73] mL/m^2 vs [35.41±11.59] mL/m^2 and [12.51±4.17] mm vs [16.04±7.37] mm), while the right ventricular EDVI and ESVI were increased ([139.72±48.70] mL/m^2 vs [116.07±44.79] mL/m^2 and [104.26±42.88] mL/m^2 vs [79.37±35.67] mL/m^2), and the differences were significant (t=-2.065,-2.286,-2.089, 2.076 and 2.668, all P<0.05). Multivariate analysis showed that left ventricular SVI and TAPSE were independent predictors of MACE in the PH patients (hazard ratio [HR]=0.942 and 0.904, P=0.039 and 0.022). The optimal cut-off values of left ventricular SVI and TAPSE determined by ROC curve were 30.27 mL/m^2 and 15.65 mm, respectively. Kaplan-Meier survival analysis showed that the incidence of MACE was significantly increased when left ventricular SVI≤30.27 mL/m^2 or TAPSE≤15.65 mm (P=0.001 and 0.019). Conclusion The left and right heart functions of PH patients with MACE are poor. TAPSE and left ventricular SVI are the independent predictors of MACE in the PH patients.