The value of interventricular septal curvature in the diagnosis of adult pulmonary artery hypertension associated with atrial septal defect by cardiac magnetic resonance
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摘要: 目的 运用心脏磁共振(CMR)分析室间隔形态与右心导管检查指标的相关性,评估室间隔曲率(CIVS)对肺动脉高压(PAH)患者的诊断价值。方法 回顾性分析32例成人房间隔缺损患者的右心导管及CMR数据。根据平均肺动脉压力(mPAP)是否≥25 mmHg(1 mmHg=0.133 kPa)分成2组:肺动脉高压组(PAH组)和肺动脉压力正常组(NPAH组)。比较2组患者CMR参数,分析CIVS与CMR参数、右心导管指标的相关性,采用受试者工作特征曲线(ROC曲线)分析CIVS判断PAH的敏感度及特异度。结果 32例成人房间隔缺损患者中有16例患者合并肺动脉高压,与NPAH组相比,PAH组舒张末期CIVS降低(P＜0.01),而收缩末期CIVS的差异无统计学意义。相关性分析显示,舒张末期CIVS与mPAP(r=-0.85, P<0.01)、肺动脉收缩压(r=-0.75, P<0.01)、肺动脉舒张压(r=-0.84,P＜0.01)显著相关。ROC曲线显示,舒张末期CIVS诊断PAH具有很高的效能,ROC曲线下面积(AUC)=0.94,特异度为94%,敏感度为81%。结论 在成人房间隔缺损的患者中,舒张末期CIVS可作为无创评估PAH的重要指标。Abstract: Objective To analyze the correlation between interventricular septum morphology and right heart catheterization indexes by cardiac magnetic resonance (CMR), and to evaluate the use of interventricular septum curvature(CIVS) in diagnosis of patients with pulmonary artery hypertension(PAH). Methods Retrospective analysis was performed where RHC and CMR data were collected from 32 adult patients with atrial septal defect (ASD).According to their mean pulmonary artery pressure (mPAP), the patients were divided into two groups: a PAH group(≥25 mmHg) and a non-PAH (NPAH) group. Both groups were compared for CMR parameters,and the correlation between CIVS and CMR parameters and RHC measurements was analyzed.The receiver operating characteristic (ROC) curve was used to analyze the use of CIVS for detection of PAH.Results In the current study, there were 16 ASD patients with PAH.Compared with the NPAH group, end-diastolic CIVS(dCIVS) decreased in the PAH group (P<0.01); and no statistical difference was found in end systolic CIVS between the two groups. There were significant correlations between dCIVS and mPAP (r =-0.85, P<0.01),between dCIVS and systolic pulmonary artery pressure(sPAP)( r =-0.75, P<0.01),between dCIVS and diastolic pulmonary artery pressure(dPAP)(r=-0.84, P<0.01).The ROC showed that dCIVS was effective for diagnosis of PAH. The AUC was 0.94, with a specificity of 94% and a sensitivity of 81%. Conclusions For adult ASD with PAH, dCIVS can be used as an important index for noninvasive evaluation of PAH.
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