The value of cardiac magnetic resonance in evaluating severe pulmonary hypertension associated with connective tissue disease

doi:10.11958/20231770

Abstract

Abstract:

Objective To evaluate the diagnostic value of cardiac magnetic resonance (CMR) in patients with severe connective tissue disease-associated pulmonary hypertension (CTD-PAH). Methods A total of 48 patients diagnosed with CTD-PAH by right heart catheterization (RHC) in Tianjin Medical University General Hospital from June 2018 to July 2021 were retrospectively included. The parameters of right ventricular (RV) morphology, function and ventricular septum (IVS) were obtained by manual delineation on CMR images and corrected by body surface area. The late gadolinium enhancement (LGE) myocardial mass (MM) and its percentage in left ventricular (LV) MM were manually sketched and calculated on LGE images. The patients were divided into the mild-moderate group and the severe group according to mean pulmonary arterial pressure (mPAP). CMR parameters were compared between the two groups. The diagnostic value of CMR for severe CTD-PAH was analyzed by receiver operating characteristic (ROC) curve. Results A total of 48 patients with CTD-PAH were included in this study. The curvature of interventricular septum (CIVS) and RV ejection fraction (EF) were lower in the severe group than those in the mild-moderate group, and the time proportion of IVS deformation, RV end-diastolic volume index (EDVI), RV end-systolic volume index (ESVI) and RV MM were higher than those in the mild-moderate group (P<0.05). ROC curve analysis showed that RV MM, time proportion of IVS deformation and RV ESVI had better diagnostic efficacy in severe CTD-PAH patients (AUC was 0.792, 0.766 and 0.731, respectively). The combined AUC of the three parameters was 0.840, specificity was 85.7% and sensitivity was 79.4%. Conclusion The parameters of RV and IVS measured by CMR can effectively evaluate patients with severe CTD-PAH and directly reflect serverity of cardiac impairment in patients with severe CTD-PAH from the morphological and functional perspective.

Key words: connective tissue diseases, pulmonary arterial hypertension, magnetic resonance imaging, ventricular septum, right heart function

CLC Number:

R445.2，R544.16，R593.2

Figures/Tables 7

References 16

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组别	n		女性	年龄/岁	身高/cm
轻中度组	34		32（94.12）	40.97±11.20	160.15±5.41
重度组	14		14（100.00）	44.86±12.99	159.71±4.89
t或Z			1.000^▲	1.043	0.259
组别		体质量/kg		BNP/（ng/L）
轻中度组		55.06±10.29		137.20（40.60，350.34）
重度组		57.93±10.00		280.50（138.50，402.25）
t或Z		0.885		1.463

组别	n		女性	年龄/岁	身高/cm
轻中度组	34		32（94.12）	40.97±11.20	160.15±5.41
重度组	14		14（100.00）	44.86±12.99	159.71±4.89
t或Z			1.000^▲	1.043	0.259
组别		体质量/kg		BNP/（ng/L）
轻中度组		55.06±10.29		137.20（40.60，350.34）
重度组		57.93±10.00		280.50（138.50，402.25）
t或Z		0.885		1.463

组别	LV MM/g			CIVS		IVS形变时间占比/%		LGE MM/g		LGE MM占比/%
轻中度组	75.42±17.66			0.41（0.27，0.55）		66.41±18.36		2.92（0.12，5.52）		3.86（0.20，7.77）
重度组	73.70±21.25			0.02（-0.28，0.48）		83.50±15.24		2.69（2.05，4.98）		5.01（2.62，7.70）
t或Z	0.289			2.100^＊		3.069^＊＊		0.455		0.910
组别		n	RV EDVI/（mL/m²）		RV ESVI/（mL/m²）		RV SVI/（mL/m²）		RV EF/%		RV MM/g
轻中度组		34	91.96±24.68		57.60±21.19		34.09±11.15		38.23±10.63		55.11±17.09
重度组		14	109.68±27.73		75.31±22.30		34.38±11.44		31.56±8.62		72.16±14.12
t或Z			2.183^＊		2.593^＊		0.081		2.078^＊		3.292^＊＊

组别	LV MM/g			CIVS		IVS形变时间占比/%		LGE MM/g		LGE MM占比/%
轻中度组	75.42±17.66			0.41（0.27，0.55）		66.41±18.36		2.92（0.12，5.52）		3.86（0.20，7.77）
重度组	73.70±21.25			0.02（-0.28，0.48）		83.50±15.24		2.69（2.05，4.98）		5.01（2.62，7.70）
t或Z	0.289			2.100^＊		3.069^＊＊		0.455		0.910
组别		n	RV EDVI/（mL/m²）		RV ESVI/（mL/m²）		RV SVI/（mL/m²）		RV EF/%		RV MM/g
轻中度组		34	91.96±24.68		57.60±21.19		34.09±11.15		38.23±10.63		55.11±17.09
重度组		14	109.68±27.73		75.31±22.30		34.38±11.44		31.56±8.62		72.16±14.12
t或Z			2.183^＊		2.593^＊		0.081		2.078^＊		3.292^＊＊

CMR参数	截断值	约登指数	AUC（95%CI）	敏感度	特异度
RV EDVI	91.25 mL/m²	0.404	0.686（0.527~0.845）	0.618	0.786
RV ESVI	54.30 mL/m²	0.429	0.731（0.589~0.873）	0.500	0.929
RV EF	24.55%	0.298	0.659（0.489~0.828）	0.941	0.357
RV MM	62.05 g	0.492	0.792（0.653~0.931）	0.706	0.786
CIVS	0.265	0.408	0.694（0.504~0.885）	0.765	0.643
IVS形变时间占比	0.82%	0.467	0.766（0.630~0.901）	0.824	0.643
联合指标		0.651	0.840（0.709~0.972）	0.794	0.857