Development of non-invasive assessment for chronic thromboembolic pulmonary hypertension using MRI

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K16452
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Radiation science
• Research Institution: Kyushu University
• Principal Investigator: Yuzo Yamasaki 九州大学, 大学病院, 助教 (00643347)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: 心臓MRI / 慢性血栓塞栓性肺高血圧 / バルーン肺動脈形成術 / 右心房機能

Outline of Final Research Achievements

Balloon pulmonary angioplasty (BPA) relieves haemodynamic stress towards the non-BPA-side vasculature and decreases its pulmonary vascular resistance (PVR) in patients with choronic thromboembolic pulmonary hypertension (CTEPH), suggesting that it can suppress or regress the progression of the small-vessel arteriopathy in non-BPA-side vasculature, presumably due to haemodynamic unloading.
The right atrial (RA) reservoir and passive conduit functions were impaired in inoperable CTEPH, whereas RA active function was preserved. BPA markedly reversed these impaired functions. The improvements in RA reservoir and conduit functions were significantly correlated with the changes in brain natriuretic peptide levels and PVR in CTEPH patients with normal RA sizes.

Free Research Field

放射線科学

Academic Significance and Societal Importance of the Research Achievements

慢性血栓塞栓性肺高血圧症は、難治性疾患克服研究事業の特定疾患治療研究事業対象疾患であり、希少疾患であるが、患者数は急増している。心臓MRIとカテーテルを組み合わせて、バルーン肺動脈形成術の治療効果発現の病態生理を明らかにしたこと（非治療側の肺血管抵抗も下げる、右心房機能も改善する）は今後の治療基準やガイドライン作成に大きく寄与するものと考えられる。また現状、本疾患の治療効果評価には侵襲的なカテーテル検査による肺動脈圧の測定が必要であり、MRIを用いた非侵襲的な治療効果判定法を提案したことは患者の負担軽減に大きく寄与する。