MR特征追踪技术评估肥厚梗阻性心肌病术后心肌重构的研究  

Myocardial remodeling assessed by MR feature tracking in hypertrophic obstructive cardiomyopathy after surgical myectomy

作　　者：杨淑娟 纪可姗 喻诗琴 闫伟鹏 李睿[2] 杨凯[1] 王生伟 王水云[4] 赵世华[1] Yang Shujuan;Ji Keshan;Yu Shiqin;Yan Weipeng;Li Rui;Yang Kai;Wang Shengwei;Wang Shuiyun;Zhao Shihua(MR Center,Fuwai Hospital,National Center for Cardiovascular Diseases of China,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Sichuan Key Laboratory of Medical Imaging,Nanchong 637007,China;Department of Cardiovascular Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vascular Diseases,Beijing 100029,China;Department of Cardiovascular Surgery Center,Fuwai Hospital,National Center for Cardiovascular Diseases of China,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院磁共振影像科,100037 [2]医学影像四川省重点实验室川北医学院附属医院放射科,南充637007 [3]北京心肺血管疾病中心首都医科大学附属北京安贞医院心外科,100029 [4]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,100037

出　　处：《中华放射学杂志》2021年第8期835-840,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金重点项目(81930044,81620108015)。

摘　　要：目的探讨肥厚梗阻性心肌病患者室间隔心肌切除手术后基于心血管MR(CMR)特征追踪技术的应变改变以及影响术后全心应变的潜在因素。方法回顾性收集2014年6月至2017年7月于中国医学科学院阜外医院行室间隔心肌切除术的肥厚梗阻性心肌病患者27例,所有患者术前及术后均行CMR心脏电影扫描。应用特征追踪技术,分别计算出手术前后左心室全心、室间隔及侧壁的径向应变(RS)、周向应变(CS)及纵向应变(LS)。采用配对样本t检验或配对Wilcoxon符号秩和检验进行手术前后的影像学参数比较。采用Pearson或Spearman相关系数以及线性回归分析探讨术后全心应变相关的影响因素。结果术后全心LS、室间隔LS、侧壁RS、侧壁CS、侧壁LS分别较术前增加,差异均有统计学意义(P均<0.05);术后全心RS、全心CS、室间隔CS均较术前减低,差异均有统计学意义(P均<0.05);室间隔RS手术前后差异无统计学意义(P=0.165)。相关性分析显示,手术年龄(r=0.428,P=0.026)、术前最大室壁厚度(r=-0.587,P=0.001)均与术后全心RS存在线性相关;随后多元逐步线性回归分析显示,仅术前最大室壁厚度与术后全心RS(调整R^(2)值=0.287,P=0.002)可能存在关联性。相关性分析显示,仅术前最大室壁厚度与术后全心CS(r=0.679,P<0.001)、术后全心LS(r=0.588,P=0.001)存在线性相关;一元线性回归分析显示,最大室壁厚度与术后全心CS(调整R^(2)值=0.337,P=0.001)、术后全心LS(调整R^(2)值=0.281,P=0.003)可能存在关联性。结论外科手术后心肌的纵向应变及侧壁应变有所改善,但会减弱全心、室间隔的周向及径向应变功能。术前最大室壁厚度可能会影响术后全心应变。Objective To investigate the changes of strains based on feature tracking in patients with hypertrophic obstructive cardiomyopathy(HOCM)after surgical myectomy and the potential factors that influenced post-myectomy global strains.Methods A total of 27 patients with HOCM who underwent septal myectomy in Fuwai Hospital from June 2014 to July 2017 were retrospectively collected.They all received cardiac MR(CMR)cine acquisitions before and after surgery.Their preoperative and postoperative strain parameters,including radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle,septum,and lateral wall,were assessed by feature tracking.Comparisons of pre-myectomy and post-myectomy imaging parameters were performed using paired-samples t-test or Wilcoxon matched-pairs signed-ranks test.Pearson or Spearman correlation analysis and linear regression analysis were utilized to find the correlated factors of postoperative global strains.Results Compared with preoperative strains,postoperative global LS,septal LS,lateral RS,lateral CS,and lateral LS increased statistically(all P<0.05);postoperative global RS,global CS,and septal CS decreased(all P<0.05);no statistically significant difference was observed in septal RS(P=0.165).Age at surgery(r=0.428,P=0.026)and preoperative myocardial maximum ventricular wall thickness(r=-0.587,P=0.001)were both linearly related to postoperative global RS;the further multivariate stepwise linear regressions showed that only preoperative myocardial maximum ventricular wall thickness might be correlated with postoperative global RS(adjusted R^(2)=0.287,P=0.002).Only myocardial maximum ventricular wall thickness was linearly related to global CS(r=0.679,P<0.001)and global LS(r=0.588,P=0.001),respectively;univariate linear regression revealed that preoperative myocardial maximum ventricular wall thickness might be correlated postoperative global CS(adjusted R^(2)=0.337,P=0.001)and postoperative global LS(adjusted R^(2)=0.281,P=0.003),respectively.Conclusio

关 键 词：心肌病 肥厚性 磁共振成像 手术 特征追踪 应变 

分 类 号：R654.2[医药卫生—外科学] R445.2[医药卫生—临床医学]