【目的】为了探讨应用4D左心房自动定量分析(4D Auto LAQ)软件测定的左房容积和应变值对鉴别毛细血管前肺动脉高压和毛细血管后肺动脉高压的价值,并与肺-左心房应变偶联指数(ePLAGS)的鉴别能力进行比较。【方法】本研究为回顾性研究,共...【目的】为了探讨应用4D左心房自动定量分析(4D Auto LAQ)软件测定的左房容积和应变值对鉴别毛细血管前肺动脉高压和毛细血管后肺动脉高压的价值,并与肺-左心房应变偶联指数(ePLAGS)的鉴别能力进行比较。【方法】本研究为回顾性研究,共纳入了自2021年7月至2022年4月就诊于中山大学附属第一医院门诊或住院部的98例高概率肺动脉高压(PH)患者,收集所有患者的临床病史及实验室资料。根据肺动脉楔压(PAWP)将所有患者分为2组:毛细血管前PH组(PAWP≤15 mmHg)及毛细血管后PH组(PAWP>15 mmHg)。所纳入的患者均接受了经胸超声心动图检查,并应用4D Auto LAQ软件自动测量左房容积和应变参数。【结果】根据PAWP的数值,入选患者分为两组:毛细血管前PH组[n=39,年龄(53±24)岁]和毛细血管后PH组[n=59,年龄(57±18)岁]。与毛细血管前PH组相比,毛细血管后PH组的最大左心房容量指数(LAVImax)、最小左心房容量指数(LAVImin)和左心房射血前的容量指数(LAVIpreA)显著增加,而左心房储备期纵向应变值(LASr)和左心房导管期纵向应变值(LAScd)明显降低。多元逻辑回归分析显示,LAVImax[OR:1.40;95%CI:(1.052,1.872);P=0.021]和LAScd[OR:1.76;95%CI:(1.183,2.489);P=0.004]是检测毛细血管后PH的强大独立预测因子。ROC曲线分析表明,LAVImax(AUC=0.82,P<0.001)和LAScd(AUC=0.78,P<0.001)在预测毛细血管后PH组方面具有很高的辨别力,其临界值分别为35.69 mL/m^(2)(敏感性86%,特异性74%)和-9%(敏感性80%,特异性70%)。【结论】:应用4D auto LAQ测量的LAVImax和LAScd是区分毛细血管前和毛细血管后PH患者有价值的参数,且其鉴别能力优于肺-左心房应变偶联指数(ePLAGS)。展开更多
BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est...BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.展开更多
目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic re...目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic resonance,CMR)在评估PH-LHF患者中的应用价值。材料与方法回顾性分析2018年9月至2020年9月期间215例确诊为左心衰(left heart failure,LHF)患者的临床和CMR参数,根据心脏超声测量的收缩期肺动脉压将患者分为两组,即LHF组(n=129)和PH-LHF组(n=86)。比较两组的基线资料和CMR参数包括心血管形态参数、心室容积功能参数以及心室心房应变参数。通过单因素及多因素logistic回归分析CMR参数中PH-LHF的独立预测因子,并绘制受试者工作特征(receiver operating characteristics,ROC)曲线评估CMR参数的诊断价值。结果PH-LHF患者组左右心室舒张末期容积指数、收缩末期容积指数、右心室心肌质量指数、室间隔角、左心房最大直径及面积、初始T1值均高于LHF组,而左右心室射血分数、右心室每搏输出量指数、右心室心脏指数低于LHF组。PH-LHF组左心室整体纵向应变、整体周向应变以及应变率、右心室整体周向应变、左心房主动应变、被动应变、总应变均不同程度下降。多因素logistic回归分析显示CMR参数中右心室射血分数,左心室整体周向应变,左心房主动应变和左心房最大直径是PH-LHF的独立预测因子。ROC曲线分析结果显示临床模型、CMR模型、联合模型诊断PH-LHF的AUC值分别为0.773、0.777、0.828,并且DeLong检验显示当加入CMR参数后,临床模型诊断效能提升(0.773 vs.0.828,P<0.05)。结论基于CMR-FT技术的心肌应变参数可以定量评估心室心房应变,反映PH-LHF患者的心肌功能以及运动情况,多参数CMR在诊断评估LHF是否合并PH中具有较好的临床增益价值。展开更多
文摘【目的】为了探讨应用4D左心房自动定量分析(4D Auto LAQ)软件测定的左房容积和应变值对鉴别毛细血管前肺动脉高压和毛细血管后肺动脉高压的价值,并与肺-左心房应变偶联指数(ePLAGS)的鉴别能力进行比较。【方法】本研究为回顾性研究,共纳入了自2021年7月至2022年4月就诊于中山大学附属第一医院门诊或住院部的98例高概率肺动脉高压(PH)患者,收集所有患者的临床病史及实验室资料。根据肺动脉楔压(PAWP)将所有患者分为2组:毛细血管前PH组(PAWP≤15 mmHg)及毛细血管后PH组(PAWP>15 mmHg)。所纳入的患者均接受了经胸超声心动图检查,并应用4D Auto LAQ软件自动测量左房容积和应变参数。【结果】根据PAWP的数值,入选患者分为两组:毛细血管前PH组[n=39,年龄(53±24)岁]和毛细血管后PH组[n=59,年龄(57±18)岁]。与毛细血管前PH组相比,毛细血管后PH组的最大左心房容量指数(LAVImax)、最小左心房容量指数(LAVImin)和左心房射血前的容量指数(LAVIpreA)显著增加,而左心房储备期纵向应变值(LASr)和左心房导管期纵向应变值(LAScd)明显降低。多元逻辑回归分析显示,LAVImax[OR:1.40;95%CI:(1.052,1.872);P=0.021]和LAScd[OR:1.76;95%CI:(1.183,2.489);P=0.004]是检测毛细血管后PH的强大独立预测因子。ROC曲线分析表明,LAVImax(AUC=0.82,P<0.001)和LAScd(AUC=0.78,P<0.001)在预测毛细血管后PH组方面具有很高的辨别力,其临界值分别为35.69 mL/m^(2)(敏感性86%,特异性74%)和-9%(敏感性80%,特异性70%)。【结论】:应用4D auto LAQ测量的LAVImax和LAScd是区分毛细血管前和毛细血管后PH患者有价值的参数,且其鉴别能力优于肺-左心房应变偶联指数(ePLAGS)。
文摘BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.
文摘目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic resonance,CMR)在评估PH-LHF患者中的应用价值。材料与方法回顾性分析2018年9月至2020年9月期间215例确诊为左心衰(left heart failure,LHF)患者的临床和CMR参数,根据心脏超声测量的收缩期肺动脉压将患者分为两组,即LHF组(n=129)和PH-LHF组(n=86)。比较两组的基线资料和CMR参数包括心血管形态参数、心室容积功能参数以及心室心房应变参数。通过单因素及多因素logistic回归分析CMR参数中PH-LHF的独立预测因子,并绘制受试者工作特征(receiver operating characteristics,ROC)曲线评估CMR参数的诊断价值。结果PH-LHF患者组左右心室舒张末期容积指数、收缩末期容积指数、右心室心肌质量指数、室间隔角、左心房最大直径及面积、初始T1值均高于LHF组,而左右心室射血分数、右心室每搏输出量指数、右心室心脏指数低于LHF组。PH-LHF组左心室整体纵向应变、整体周向应变以及应变率、右心室整体周向应变、左心房主动应变、被动应变、总应变均不同程度下降。多因素logistic回归分析显示CMR参数中右心室射血分数,左心室整体周向应变,左心房主动应变和左心房最大直径是PH-LHF的独立预测因子。ROC曲线分析结果显示临床模型、CMR模型、联合模型诊断PH-LHF的AUC值分别为0.773、0.777、0.828,并且DeLong检验显示当加入CMR参数后,临床模型诊断效能提升(0.773 vs.0.828,P<0.05)。结论基于CMR-FT技术的心肌应变参数可以定量评估心室心房应变,反映PH-LHF患者的心肌功能以及运动情况,多参数CMR在诊断评估LHF是否合并PH中具有较好的临床增益价值。
