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Yuan Li

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Open access Sep 2026

Association Between MRI-Derived Right-to-Left Ventricular Volume Ratio and Regional Left Ventricular Myocardial Dysfunction in Patients With Pulmonary Arterial Hypertension.

BACKGROUND Right ventricular (RV) to left ventricular (LV) end-diastolic volume ratio (RV/LV) is a validated marker of RV dilation in pulmonary arterial hypertension (PAH), yet its impact on LV myocardial function and the underlying mediating pathway is incompletely characterized. PURPOSE To investigate the association between RV/LV volume ratio and LV dysfunction in PAH patients, with a focus on regional strain patterns and mediating pathways. STUDY TYPE Retrospective. POPULATION 188 PAH patients were divided into normal (ratio < 1.27, n = 74) and elevated (ratio ≥ 1.27, n = 114) RV/LV volume ratio groups, and 81 age- and sex-matched controls. FIELD STRENGTH/SEQUENCE 3.0-T/balanced steady-state free precession cine sequence. ASSESSMENT LV global longitudinal, circumferential, and radial strains (LVGLS, LVGCS, and LVGRS, respectively) and regional strains were measured using feature tracking. Strain parameters were compared among controls and PAH subgroups. STATISTICAL TESTS One-way ANOVA with Bonferroni-corrected post hoc tests, Kruskal-Wallis test, and Pearson or Spearman correlation. Multivariable linear regression was used to identify independent determinants and mediation analysis to examine the mediating pathways. A two-tailed p < 0.05 was deemed statistically significant. RESULTS PAH patients with elevated volume ratio had significantly reduced LVGCS and LVGLS. Regional analysis showed that the most extensive strain impairment was at the mid-ventricular septum. The RV/LV volume ratio was independently associated with LVGCS (β = -0.194) and LVGLS (β = -0.307). Mediation analysis demonstrated that the mPAP-LVGLS relationship was statistically mediated by the RV/LV volume ratio, with a significant indirect effect (β = -0.192, 95% confidence interval: -0.302 to -0.096) and a non-significant (p = 0.544) direct effect. DATA CONCLUSION Elevated RV/LV volume ratio in PAH is associated with spatially heterogeneous LV strain impairment, with the mid-septum being most vulnerable. The ratio mediates the adverse impact of pulmonary pressure on LV longitudinal strain and may serve as an imaging marker for assessing LV dysfunction. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 3.

Han Fang, Yuan Li, Jin Wang et al. · Journal of Magnetic Resonanc... · 1 citation

Case report Open access Aug 2026

Thrombus aspiration and in situ thrombolysis via a 6F Guidezilla catheter in elderly patients with high-risk pulmonary embolism: a case series of six patients

Background Systemic thrombolysis is often not an option for elderly patients with PE because of bleeding risk. Large-bore catheters (16F−24F) can injure fragile vessels. The 6F Guidezilla guide extension catheter, already used in coronary cases, offers a smaller-caliber choice for thrombus aspiration and local thrombolysis. We report six elderly patients with high-risk PE treated with this approach. Methods Six consecutive patients with intermediate-high or high-risk PE underwent thrombus aspiration and in situ thrombolysis through a 6F Guidezilla catheter (March 2024 to January 2026). Agents used: recombinant human prourokinase 15–30 mg or urokinase 2 million IU. All had contraindications to systemic thrombolysis. We collected baseline data, procedural metrics, Miller scores (pre/post), SpO₂, hemodynamics, complications, hospital stay, and 30-day outcomes. Results The mean age of the patients was 75.8 ± 4.6 years (range 70–81 years), with five patients aged ≥70 years. One patient presented with high-risk PE (shock), and the remaining five were classified as intermediate-high risk. The mean simplified Pulmonary Embolism Severity Index (sPESI) score was 2.7 ± 1.2. The mean Miller score decreased significantly from 18.0 ± 6.7 pre-procedure to 5.2 ± 3.6 post-procedure (P < 0.05), with a mean clot clearance rate of 74.1% ± 15.2%. SpO₂ improved from 84.5% ± 5.0% pre-procedure to 97.2% ± 0.8% at 24 h post-procedure (P < 0.01). The high-risk patient was successfully weaned off vasopressors within 24 h of the procedure. No major bleeding or procedure-related deaths occurred during hospitalization. The mean hospital stay was 7.8 ± 4.4 days, and no recurrent PE or death was observed within 30 days of follow-up. Conclusion The 6F Guidezilla catheter appears safe and effective for thrombus aspiration and in situ thrombolysis in elderly PE patients who cannot receive systemic thrombolysis. It achieves good clot clearance, quick clinical recovery, and few complications. When large-bore catheters are unavailable or too risky for elderly vessels, this technique is a practical alternative.

Peng Li, Chengyu Wang, Chu Guo et al. · Frontiers in Cardiovascular... · 0 citations