Talk_1_-_cardiac_imaging_and_biomarkers英文版 医学资料.ppt

Delayed contrast enhancement Proportional reductions in curvature ratio associated with abnormal increases in RVSP End-systolic short-axis cine CMR images: Dellegrottaglie et al Radiology 2007; 243: 63–69. Septal curvature Dellegrottaglie et al Radiology 2007; 243: 63–69. Receiver operating characteristic curve shows the curvature ratio (C-ratio) to have good diagnostic accuracy in the prediction of PH (RVSP40mmHg). Phase contrast images of pulmonary blood flow Volumetric flow (ml/s) is obtained in each time frame by multiplying the spatial mean velocity (cm/s) of blood flow with the cross-sectional area of the vessel (cm2). Integrating the volumetric flow curve over systole gives the right ventricular stroke volume van Wolferen et al 2007 Survival according to baseline median cardiac MRI variables in patients with PH Spindler M et al 2005 NMR spectroscopy of cardiac muscle Limitations of MR imaging Expensive Claustrophobia and cannot image metal Still some work to be done on measuring PAP Clinical parameter CMR Echo RHC CT Nuclear RV volume +++ ++ + ++ + Ejection fraction +++ + + ++ - RV mass +++ + - ++ - RV pressure + ++ +++ - - Septal curvature +++ + - - - RA size/volume +++ + - + - Tricuspid regurgitation ++ +++ - - - Pulmonary artery size +++ + + +++ - Pulmonary artery compliance +++ + + - - Pulmonary artery flow +++ + +++ - - Qp:Qs (shunt) +++ + +++ - - Pericardial effusion +++ ++ - ++ - Comparison of imaging modalities Pre-pro-BNP (1-134) Pro-BNP (1-108) 26-aa signal sequence NT-proBNP (1-76) BNP (77-108) Clearance Natriuresis Inhibition renin Vasorelaxation B-type natriuretic peptide (BNP) B-type natriuretic peptide (BNP) Synthesised by myocardium and release increased by myocardial wall stress N-terminal proBNP and BNP-32 released in equimolar amounts BNP-32 acts to reduce wall stress Both measurable in plasma BNP BNP DAPI DAPI normal RV RVH x40 Human Right Ventricle NT-proBNP as prognostic biomarkers Nagaya et al Circ 2000 To understand why