心脏MR评估大动脉炎肺动脉受累患者心肌结构及功能受损表现  

Impaired myocardial structure and function assessment by cardiac MR in Takayasu arteritis with pulmonary artery involvement

作　　者：刘明熙[1] 李文欢 郭晓娟[1] 刘敏[2] 龚娟妮[3] 马展鸿[1] 杨媛华[3] 蒋涛[1] 杨旗 Liu Mingxi;Li Wenhuan;Guo Xiaojuan;Liu Min;Gong Juanni;Ma Zhanhong;Yang Yuanhua;Jiang Tao;Yang Qi(Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院放射介入影像中心,北京100020 [2]中日友好医院放射诊断科,北京100029 [3]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020

出　　处：《中华放射学杂志》2023年第6期653-660,共8页Chinese Journal of Radiology

基　　金：国家重点研发计划(2021YFC2501100);国家自然科学基金(82272081);中国医学科学院医学与健康科技创新工程(2022-I2M-C&T-B-109)。

摘　　要：目的分析临床明确诊断为大动脉炎肺动脉受累(PTA)患者心脏磁共振(CMR)心肌延迟强化(LGE)、心功能参数及组织特征追踪技术(FT)所得的心室心肌整体应变情况,探讨其心肌结构及功能受损表现。方法回顾性选择2017年1月到2020年12月临床明确诊断为PTA的患者32例和无心肺疾病的健康受试者21名,且均进行了CMR检查。依据有无肺动脉高压(PAH),将PTA患者分为PAH组(11例)和非PAH组(21例),应用Fisher精确检验比较两组PTA患者间心肌LGE表现的差异。进一步应用单因素方差分析或非参数Kruskal-Wallis检验比较PAH组、非PAH组患者和健康对照组心功能参数,以及左、右心室心肌的整体应变峰值,并进行组间两两比较。将PAH组上述FT参数值与右心导管检查(RHC)所得的血流动力学参数、经胸超声心动图估测的肺动脉收缩压进行Pearson或Spearman相关性分析。结果PTA患者存在心肌LGE阳性者23例(71.9%)。PAH组心室结合部(IP)(11/11)、心肌中层(11/11)或心外膜下(10/11)与非PAH组IP部(11/21)、心肌中层(7/21)或心外膜下(9/21)比较,更易出现LGE阳性(P值分别为0.006、<0.001和0.011)。PAH组左心室整体周向应变峰值(LVGPCS)、左心室整体纵向应变峰值(LVGPLS)和右心室整体纵向应变峰值较健康对照组绝对值均明显减低(P<0.05),非PAH组LVGPCS和LVGPLS绝对值小于健康对照组(P<0.05)。PAH组中RHC所得平均肺动脉压与多个FT参数值相关性良好(P<0.05),尤其是左心室整体径向应变峰值(r=-0.807,P=0.009)和LVGPCS(rs=0.817,P=0.007)。结论PTA患者可出现心肌损伤,且合并PAH的患者更易出现IP部、心肌中层或心外膜下LGE。LVGPCS和LVGPLS可早期提示未合并PAH的PTA患者左心功能障碍。Objective To analyze the late gadolinium enhancement(LGE)manifestations,cardiac function,and myocardial strain by feature tracking(FT)in Takayasu arteritis(TA)with pulmonary artery involvement(PTA)using cardiac MR(CMR),and then to investigate manifestations of the impaired myocardial structure and function.Methods A retrospective study was performed on 32 patients with PTA and 21 healthy subjects without cardiopulmonary diseases from January 2017 to December 2020.All of them underwent CMR examinations.According to the presence of pulmonary arterial hypertension(PAH),PTA patients were divided into two groups including PAH group(11 cases)and non-PAH group(21 cases).LGE manifestations were observed and Fisher exact test was used for statistical analysis between the two groups.Cardiac function parameters and FT values including global peak strain of the left and right ventricle were calculated separately in PAH,non-PAH group of patients and healthy controls,using One-way ANOVA or non-parametric Kruskal-Wallis test for statistical analysis including a pairwise comparison between groups.The correlations between FT values of the PAH group and parameters measured by right heart catheterization test(RHC)and transthoracic echocardiography were analyzed using Pearson or Spearman correlation analysis.Results There were 23 PTA patients(71.9%)with LGE.LGE in the interventricular insertion points(IPs)(11/11),and in the mid-wall(11/11)or epicardial(10/11)myocardium was more common(P values were 0.006,<0.001 and 0.011,respectively)in PAH group,compared with LGE in the IPs(11/21),and in the mid-wall(7/21)or epicardial(9/21)myocardium in non-PAH group.The absolute values of left ventricular global peak circumferential strain(LVGPCS),left ventricular global peak longitudinal strain(LVGPLS)and right ventricular global peak longitudinal strain in PAH group were smaller than those in healthy subjects(P<0.05).The absolute values of LVGPCS and LVGPLS in non-PAH group were smaller than those in healthy subjects(P<0.05).In PAH group,mean p

关 键 词：磁共振成像 大动脉炎 组织追踪 应变 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]