OBJECTIVES To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA. METHODS We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%. RESULTS ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = - 41.2, - 13.8, - 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = - 37.2, - 29.5, - 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56). CONCLUSIONS Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI. KEY POINTS • Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains. • Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA. • Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.

中文翻译：

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右心室3D区域应变在评估慢性血栓栓塞性肺动脉高压中球囊肺血管成形术的治疗效果中的临床价值：与2D特征跟踪MRI的比较。

目的为了评估通过心脏MRI（CMRI）进行的右室（RV）区域应变分析作为评估无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）的球囊肺血管成形术（BPA）的治疗效果的工具的有效性，比较了RV区域应变在BPA之前和之后使用特征跟踪MRI（FTMRI）将二维应变转换为二维（2D）应变。方法我们回顾性分析了21名接受BPA的CTEPH患者。在BPA之前和之后分别测量了收缩末期总面积应变（GAS），纵向应变（LS），周向应变（CS）和径向应变（RS）。BPA后GAS和RV射血分数（RVEF）值的变化定义为ΔGAS和ΔRVEF。进行受试者工作特征（ROC）分析以确定BPA后菌株的最佳截止值，以检测平均肺动脉压降低（mPAP）小于30 mmHg和RVEF升高大于50％的病情改善的患者。结果ROC分析显示了用于鉴定mPAP <30 mmHg的改良患者的最佳菌株（GAS，LS，CS和RS）临界值（临界值（％）=-41.2，-13.8，-16.7和14.4：曲线下面积） ，0.75、0.56、0.65和0.75）和RVEF> 50％的患者（临界（％）=-37.2，-29.5，-2.9和14.4：曲线下面积0.81、0.60、0.56和0.56）。结论通过CMRI进行面积应变分析可能比使用FTMRI的2D菌株更有效地评估BTE对CTEPH患者的治疗效果。要点•面积应变值可以检测到球囊肺血管成形术（BPA）后右心室（RV）压力和功能的改善，其准确性或准确性要高于二维应变。•区域应变分析是一种有用的分析方法，可反映BPA对复杂RV心肌变形的改善。•区域应变分析是一种可靠的方法，其可重复性与2D应变分析的可重复性相同。