European Radiology:四维血流CMR评价高血压患者左心室血流动能的初步研究

2023-11-29 shaosai MedSci原创 发表于上海

四维(4D)血流心脏磁共振(CMR)是一种能够全面评估血流动力学的技术。四维血流CMR可以进行三维成像以及动能(KE)计算,随后可以对LV腔内血流KE进行定量分析。

高血压(HTN)是导致左心室(LV)压力过载的最常见危险因素,导致LV肥大、弥漫性间质纤维化和LV复杂的血流动力学变化,最后导致舒张期和/或收缩期心力衰竭。然而,左心室的血流动力学异常预示着功能的不适应。因此,血流分析可揭示临床前的左心室血流动力学变化,如不连贯的破裂涡流、纵向和横向推力,甚至在左心室结构发生变化之前识别由高血压引起的湍流等。

四维(4D)血流心脏磁共振(CMR)是一种能够全面评估血流动力学的技术。四维血流CMR可以进行三维成像以及动能(KE)计算,随后可以对LV腔内血流KE进行定量分析。血流KE是利用血液的质量和速度来计算的,代表了心脏收缩期/舒张期运动所做功的基本组成部分。研究表明,在健康人中,E波峰值KE值随年龄增长而逐渐下降,而收缩期KE值保持不变。因此,与年龄相关的LV舒张期能量的变化可能是生理性的或临床前的病理变化。据我们所知,到目前为止,还没有使用四维血流成像评估高血压患者左心室血流动力学变化的相关研究。此外,细胞外体积分数(ECV)可用来评估心肌间质纤维化,具有潜在预后价值有助于指导心血管疾病的风险分层。


近日,发表在European Radiology杂志的一项研究比较了HTN患者和健康对照组的LV血流KE参数以及射血分数保留的HTN患者(HTN-pEF)和射血分数降低的HTN患者(HTN-rEF)亚组的LV血流KE参数,并探讨了HTN患者的LV血流KE参数与ECV的相关性。

本项研究对42名高血压患者和20名年龄/性别匹配的健康对照者进行了CMR检查,包括cines、前/后T1 mapping和全心4D血流成像,并进行了回顾性评估。高血压患者进一步分为两个亚组:射血分数保留(HTN-pEF)和射血分数降低(HTN-rEF)。KE参数与左心室舒张末期容积(EDV)挂钩,并可得到平均的左心室、最小、收缩期、舒张期、E波峰值、A波峰值、E波和A波KEiEDV,以及左心室平面内KE的比例(%)时间差(TD)。这些参数在高血压组和健康对照组以及两个亚组之间进行了比较。使用多变量回归分析,分析了HTN组的LV血流KE参数与LV功能和细胞外容积分数(ECV)的相关性。 

高血压组的E波峰值KEiEDV明显低于健康对照组(P=0.01),而平面内KE和TD则明显高于健康对照组(均P<0.01)。与HTN-pEF亚组相比,HTN-rEF亚组的平面内KE和TD的比例明显增加(均P<0.01)。只有平面内KE的比例与ECV有独立的相关性(β* = 0.59, p < 0.01)。 


 健康对照组和高血压患者的LV血流KE和面内速度流线图。第一幅:收缩期峰值时整个LV血流KE图的短轴图像。与HTN-pEF患者和健康对照组相比,HTN-rEF患者在流出道的KE值较低。第二幅:与第一幅相同的三个病例的面内速度流线。HTN-rEF患者与HTN-pEF患者和健康对照组相比,舒张早期平面内血流的比例增加。HTN-rEF患者的ECV最高

本项研究表明,E波峰值KEiEDV的降低和平面内KE比例的增加,TD反映了高血压患者LV血流的改变,而平面内KE的比例与ECV独立相关。

原始出处:

Kun Peng,Xueli Zhang,Ting Hua,et al.Evaluation of left ventricular blood flow kinetic energy in patients with hypertension by four-dimensional flow cardiovascular magnetic resonance imaging: a preliminary study.DOI:10.1007/s00330-023-09449-8

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2171629, encodeId=b5f821e1629fd, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210614/b89561848b4d4381afb94afea7fd767a/9bddf5c1acfa48a6a9fe859d9f319af2.jpg, createdBy=86c95500567, createdName=李木6000000170503179, createdTime=Wed Nov 29 09:16:37 CST 2023, time=2023-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2171617, encodeId=c55021e1617fe, content=高血压(HTN)是导致左心室(LV)压力过载的最常见危险因素, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d3d3015017, createdName=jshbyywk2008, createdTime=Wed Nov 29 08:15:59 CST 2023, time=2023-11-29, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2171606, encodeId=8ea321e16063a, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Wed Nov 29 06:14:42 CST 2023, time=2023-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2171514, encodeId=1f4521e1514dd, content=<a href='/topic/show?id=1c1710265113' target=_blank style='color:#2F92EE;'>#高血压#</a> <a href='/topic/show?id=982b4908df' target=_blank style='color:#2F92EE;'>#CMR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4908, encryptionId=982b4908df, topicName=CMR), TopicDto(id=102651, encryptionId=1c1710265113, topicName=高血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Nov 28 18:02:09 CST 2023, time=2023-11-28, status=1, ipAttribution=上海)]
    2023-11-29 李木6000000170503179

    学习啦

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2171629, encodeId=b5f821e1629fd, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210614/b89561848b4d4381afb94afea7fd767a/9bddf5c1acfa48a6a9fe859d9f319af2.jpg, createdBy=86c95500567, createdName=李木6000000170503179, createdTime=Wed Nov 29 09:16:37 CST 2023, time=2023-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2171617, encodeId=c55021e1617fe, content=高血压(HTN)是导致左心室(LV)压力过载的最常见危险因素, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d3d3015017, createdName=jshbyywk2008, createdTime=Wed Nov 29 08:15:59 CST 2023, time=2023-11-29, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2171606, encodeId=8ea321e16063a, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Wed Nov 29 06:14:42 CST 2023, time=2023-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2171514, encodeId=1f4521e1514dd, content=<a href='/topic/show?id=1c1710265113' target=_blank style='color:#2F92EE;'>#高血压#</a> <a href='/topic/show?id=982b4908df' target=_blank style='color:#2F92EE;'>#CMR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4908, encryptionId=982b4908df, topicName=CMR), TopicDto(id=102651, encryptionId=1c1710265113, topicName=高血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Nov 28 18:02:09 CST 2023, time=2023-11-28, status=1, ipAttribution=上海)]
    2023-11-29 jshbyywk2008 来自河北省

    高血压(HTN)是导致左心室(LV)压力过载的最常见危险因素

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    2023-11-29 1212ad1cm87暂无昵称

    不错,学习了。

    0

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    2023-11-28 梅斯管理员 来自上海

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