心脏磁共振在肺动脉高压病情评估中的作用及临床意义

doi:10.3877/cma.j.issn.1674-6902.2019.03.008

目的

探讨心脏磁共振(MRI)在肺动脉高压患者病情评估中的作用。

方法

选取2012年6月至2018年10月就诊于新疆军区总医院的成年、能耐受右心漂浮导管检查的肺动脉高压患者25例，每例患者均进行右心漂浮导管及心脏磁共振检查，分别测量右心漂浮导管及心脏磁共振相关指标，并分析其相关性。

结果

为消除因个体差异对的解剖学数据造成影响，故将经MRI测得的肺动脉主干内径、右肺动脉主干内径、右心室前壁厚度分别与右膈顶平面胸横径做比值，单因素方差分析发现，肺动脉主干内径/右膈顶平面胸横径(MPA/T)、右肺动脉主干内径/右膈顶平面胸横径(RAP/T)、右心室前壁厚度/右膈顶平面胸横径(RVW/T)观察组及对照组之间差异有统计学意义(P<0.05)，经右心漂浮导管测得的肺动脉收缩压(PASP)、肺动脉平均压(PAMP)、全肺阻力(PVR)观察组与对照组之间差异均有统计学意义(P<0.05)。将解剖学指标MPA/T、RAP/T、RVW/T与PASP、PAMP及PVR分别做相关性分析后得出除RAP/T与PVR的P>0.01，其余均P<0.01，说明MPA/T、RAP/T与PASP、PAMP、PVR呈正相关，RVW/T与PASP、PAMP呈正相关。

结论

心脏磁共振检查所得的解剖指标、MPA/T、RAP/T、RVW/T可用于评价有无肺动脉高压及评估肺动脉高压程度，有重要临床意义。

关键词: 肺动脉高压, 右心漂浮导管, 心脏磁共振, 临床意义

Objective

To study the role of cardiac magnetic resonance in the evaluation of pulmonary hypertension.

Methods

From June 2012 to October 2018, 25 patients with pulmonary hypertension who were admitted to the General Hospital of Xinjiang Military Command, Urumqi, China, and were able to tolerate the right heart floating catheter examination were selected for this study. Each patient was subjected to a right heart floating catheter examination and a heart magnetic resonance examination. The related indicators of the right heart floating catheter examination and cardiac magnetic resonance examination were measured respectively and the relevance was analyzed.

Results

In order to eliminate the influence of individual differences on the anatomical data, the inner diameter of the pulmonary trunk, the inner diameter of the right pulmonary trunk and the thickness of the anterior wall of the right ventricle measured by magnetic resonance imaging (MRI) were compared with the transverse diameter of the right diaphragm top plane. The results of one-way analysis of variance (ANOVA) showed that there existed significant differences between the inner diameter of the pulmonary trunk/the transverse diameter of the right diaphragm top plane (MPA/T), the inner diameter of the right pulmonary trunk/the transverse diameter of the right diaphragm top plane (RAP), and the thickness of the anterior wall of the right ventricle/the transverse diameter of the right diaphragm top plane (RVW/T) between the experimental group and the control group (P<0.05). There were significant differences in the pulmonary arterial systolic pressure (PASP), the pulmonary arterial mean pressure (PAMP) and the pulmonary vascular resistance (PVR) between the experimental group and the control group (P<0.05). The correlation analysis of the anatomical indexes, MPA/T, RAP/T, RVW/T, and PASP, PAMP and PVR showed that except for RAP/T and PVR (P>0.01), the P values of the rest indicators were less than 0.01, indicating that MPA/T and RAP/T were positively correlated with PASP, PAMP and PVR, and RVW/T was positively correlated with PASP and PAMP.

Conclusion

The anatomical indexes, MPA/T, RAP/T, and RVW/T, obtained from cardiac magnetic resonance examination, can be used to evaluate the presence or absence of pulmonary arterial hypertension and assess the degree of pulmonary arterial hypertension, it has important clinical significance.

Key words: Pulmonary hypertension, Right heart floating catheter examination, Cardiac magnetic resonance, Clinical significance

图1 心脏磁共振成像图；注：A：右心室前壁舒张末期厚度；B：主肺动脉宽度；C：右肺动脉宽度；D：左肺动脉宽度

表1 两组解剖参数比较(mm，±s)

组　别	例数	MPA/T	RVW/T	RPA/T	LPA/T
观察组	25	1.22±0.11^a	0.50±0.08P^a	0.83±0.06^a	0.85±0.07^a
对照组	10	0.66±0.02	0.31±0.02	0.48±0.03	0.53±0.02

表1 两组解剖参数比较(mm，±s)

组　别	例数	MPA/T	RVW/T	RPA/T	LPA/T
观察组	25	1.22±0.11^a	0.50±0.08P^a	0.83±0.06^a	0.85±0.07^a
对照组	10	0.66±0.02	0.31±0.02	0.48±0.03	0.53±0.02

表2 两组有心导管测量血流动力学参数比较(±s)

组　别	例数	PASP(mmHg)	PAMP(mmHg)	PVR(wood)
观察组	25	89.48±24.32^a	40.04±10.99^a	11.33±5.25^a
对照组	10	42.8±11.29	10.6± 1.57	1.21± 0.44

表2 两组有心导管测量血流动力学参数比较(±s)

组　别	例数	PASP(mmHg)	PAMP(mmHg)	PVR(wood)
观察组	25	89.48±24.32^a	40.04±10.99^a	11.33±5.25^a
对照组	10	42.8±11.29	10.6± 1.57	1.21± 0.44

表3 心脏磁共振解剖参数与导管血流动力学参数的相关分析

组　别	PASP		PAMP		PVR
组　别	r值	P值	r值	P值	r值	P值
MAP/T	0.802	<0.01	0.915	<0.01	0.816	<0.01
RAP/T	0.795	<0.01	0.852	<0.01	0.806	>0.01
RVW/T	0.78	<0.01	0.904	<0.01	0.802	<0.01

表3 心脏磁共振解剖参数与导管血流动力学参数的相关分析

组　别	PASP		PAMP		PVR
组　别	r值	P值	r值	P值	r值	P值
MAP/T	0.802	<0.01	0.915	<0.01	0.816	<0.01
RAP/T	0.795	<0.01	0.852	<0.01	0.806	>0.01
RVW/T	0.78	<0.01	0.904	<0.01	0.802	<0.01

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Role of cardiac magnetic resonance in evaluation of pulmonary hypertension

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Role of cardiac magnetic resonance in evaluation of pulmonary hypertension