Energy efficiency and pulmonary artery flow after balloon pulmonary angioplasty for inoperable, chronic thromboembolic pulmonary hypertension: Analysis by phase-contrast MRI

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• 作者：Michinobu Nagao^a ; ^{nagao.michinobu@twmu.ac.jp} ; Yuzo Yamasaki^b ; Kohtaro Abe^c ; Kazuya Hosokawa^c ; Satoshi Kawanami^d ; Takeshi Kamitani^b ; Torahiko Yamanouchi^b ; Hidetake Yabuuchi^e ; Kenji Fukushima^a ; Hiroshi Honda^b
• 关键词：BPA ; balloon pulmonary angioplasty ; CTEPH ; chronic thromboembolic pulmonary hypertension ; ECG ; electrocardiogram ; EF ; ejection fraction ; EDV ; end-diastolic volume ; MRI ; magnetic resonance imaging ; PA ; pulmonary artery ; PAP ; pulmonary artery pressure ; PEA ; pulmonary endarterectomy ; RHC ; right heart catheterization ; ROC ; receiver-operating-characteristic ; RV ; right ventricle
• 刊名：European Journal of Radiology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：87
• 期：Complete
• 页码：99-104
• 全文大小：1004 K
• 卷排序：87

文摘

The aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methodsPC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2 mV2 (μj/kg), and energy loss was defined as the following equation “energy loss = main PA energy − (rt. PA energy + lt. PA energy)”.ResultsRight PA energy was significantly greater post-BPA than pre-BPA (61 ± 55 vs. 32 ± 40 μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18 ± 97 μj/kg) than pre-BPA (79 ± 125 μj/kg). An optimal cutoff of left PA energy of 45 μj/kg pre-BPA can be used to predict patients with mPAP ≥ 30 mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity.ConclusionAnalysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment.