二叶式主动脉瓣患者左心室心肌应变参数磁共振定量研究  

Quantitatively study of left ventricular myocardial strain in patients with bicuspid aortic valve by magnetic resonance imaging

作　　者：石春彦 张宏凯 高一峰 张楠[1] 刘家祎[1] 徐磊[1] 范占明[1] SHI Chunyan;ZHANG Hongkai;GAO Yifeng;ZHANG Nan;LIU Jiayi;XU Lei;FAN Zhanming(Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所医学影像科,100029

出　　处：《心肺血管病杂志》2022年第2期179-183,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金面上项目(81771791)。

摘　　要：目的:探讨二叶式主动脉瓣(BAV)患者左心室心肌应变的磁共振定量特征,为临床提供更多手术预后预测参考信息。方法 :回顾性分析2015年12月至2021年4月在北京安贞医院行CMR检查的BAV患者作为病例组(BAV组),另选取同期无心血管疾病且CMR无异常表现的人群作为对照组。采用心脏磁共振组织追踪(CMR-TT)技术测量左心室心肌应变参数,包括整体径向应变峰值(GPRS)、周向应变峰值(GPCS)、纵向应变峰值(GPLS)和扭转力(Torsion)。根据主动脉瓣狭窄程度将BAV组分成无或轻度狭窄组,中或重度狭窄组。比较BAV组与对照组的差异,并分析与应变参数间的相关性。结果 :与对照组比较,BAV组患者GPRS、GPCS、GPLS、Torsion均较低(P均<0.01),其中中或重度主动脉瓣狭窄组GPRS、GPCS、GPLS较无或轻度主动脉瓣狭窄组均减低(P均<0.01),而左心室Torsion差异无统计学意义(P=0.23)。相关分析结果显示,GPRS、GPCS、GPLS值与BAV患者的LVEF值呈正相关(r分别为0.907、0.784和0.745,P均<0.0001),而与主动脉瓣狭窄程度呈负相关(r分别为-0.618、-0.602和-0.505,P均<0.01)。Torsion与BAV患者的LVEF值呈正相关(r=0.483,P<0.05),与V/M呈负相关(r=-0.431,P<0.05)。结论 :BAV患者瓣膜功能障碍会导致左心室心肌应变的改变;多参数CMR定量评估有助于BAV患者心脏功能障碍风险分层。Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with bicuspid aortic valve(BAV). Methods: In this retrospective study, patients with BAV, who underwent CMR examinations at Beijing Anzhen Hospital from December 2015 to April 2021, were selected as the case group(BAV group), and those without cardiovascular diseases and with normal CMR results were selected as control group. Left ventricle(LV) global peak radial, circumferential, longitudinal strains(GPRS, GPCS and GPLS, respectively) and torsion were measured by three-dimensional Cardiac Magnetic Resonance Tissue Tracking(CMR-TT). The BAV group was further divided into two subgroups: one with no or mild aortic valve stenosis and the other with moderate or severe stenosis. Independent sample t-test and Fisher’s exact test(n<40) were used to compare the differences between BAV and control groups, and the correlation analysis were also conducted on the strain parameters. Results: Compared with the control group,GPRS, GPCS, GPLS, and torsion were all lower in the BAV group(all P<0.01). Among them, GPRS,GPCS, and GPLS in the moderate to severe aortic stenosis group were lower than those in the mild aortic stenosis group(all P <0.01), but the difference in left ventricular torsion was not statistically significant(P=0.23). The correlation analysis on the BAV group showed that the GPRS, GPCS, and GPLS values were positively correlated with the LVEF values(r =0.907, 0.784, and 0.745, respectively, all P <0.0001), and negatively correlated with the degree of aortic valve stenosis(r =-0.618,-0.602 and-0.505, all P<0.01). The left ventricular torsion is positively correlated with the LVEF value in BAV patients(r =0.483, P<0.05), but is negatively correlated with V/M(r=-0.431, P<0.05). Conclusions: Left ventricular myocardial strain has changed in BAV patients;multi-parameter CMR quantitative assessment may be helpful in risk stratification of cardiac dysfunction in valve dysfunction patients.

关 键 词：二叶式主动脉瓣 心脏磁共振成像 主动脉瓣狭窄 心功能 心肌应变 

分 类 号：R54[医药卫生—心血管疾病]