基于组织特征追踪的心脏磁共振左房应变分析在肥厚型心肌病左室舒张功能障碍评估中的价值  

Value of cardiac magnetic resonance left atrial strain analysis based on tissue feature tracking in the assessment of left ventricular diastolic dysfunction in hypertrophic cardiomyopathy

作　　者：岳炫彤 杨凯[1] 李静惠[1] 尹刚[1] 赵世华[1] 陆敏杰[1] YUE Xuantong;YANG Kai;LI Jinghui;YIN Gang;ZHAO Shihua;LU Minjie(Department of Magnetic Resonance Imaging,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Radiology,Sichuan Science City Hospital,Mianyang 621000,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心血管疾病重点实验室阜外医院磁共振影像科,北京100037 [2]四川省科学城医院放射科,绵阳621000

出　　处：《磁共振成像》2024年第9期60-67,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家科技重大专项(编号:2023ZD0504502);中央高水平医院临床科研业务费(编号:2022-GSP-QZ-5);国家自然科学基金项目(编号:82471973,81930044)。

摘　　要：目的探索磁共振左心房应变(left atrial strain,LAS)在肥厚型心肌病(hypertrophic cardiomyopathy,HCM)左室舒张功能障碍(left ventricular diastolic dysfunction,LVDD)诊断中的价值。材料与方法回顾性分析2021年2月至2022年8月中国医学科学院阜外医院诊断的103例HCM住院患者的临床资料、超声心动图、心脏磁共振(cardiac magnetic resonance,CMR)基本参数、基于组织特征追踪的左室应变(left ventricular strain,LVS)及LAS参数,根据超声心动图结果将上述患者分为28例LVDD组(A组)以及75例无明显LVDD组(B组)。采用独立样本t检验、非参数检验、卡方检验等统计方法,分别比较A组与B组的临床基线资料、CMR基本参数、LVS及LAS参数,同时采用logistic回归分析筛选LVDD的独立相关因素。结果A组患者的年龄更大[中位年龄为53.0(43.2,66.8)岁]、纽约心功能分级(New York HeartAssociation,NYHA)Ⅲ~Ⅳ(60.7%)更高,出现晕厥(32.1%)、猝死家族史(32.1%)等临床症状的比例更高。与B组比较,A组左房前后径(left atrial anteroposterior diameter,LAD-AP)、左心室收缩末期容积指数(left ventricular end-systolic volume index,ESVi)、左心室质量指数(left ventricular mass index,LVMi)及左室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)的比例均显著增高(P值均<0.05),被动应变(passive strain,εe)、峰值正应变率(peak positive strain rate,SRs)、峰值早期负应变率(peak early negative strain rate,SRe)及峰值晚期负应变率(peak late negative strain rate,SRa)均显著降低(P均<0.05)。多因素logistic回归分析显示LVOTO[优势比(odds ratio,OR)=4.127,95%置信区间(confidence interval,CI):1.488~11.450,P=0.006]及SRa(OR=4.672,95%CI:1.624~13.441,P=0.004)与LVDD独立相关,且SRa具有较高的诊断效能,其区分LVDD的受试者工作特征(receiver operator characteristic,ROC)曲线下面积(area under the curve,AUC)为0.717。结论磁共振LAS可反映HCM患者的LVDD。SRa对LVDD有一定的诊�Objective:To explore the value of cardiac magnetic resonance(CMR)left atrial strain(LAS)in the diagnosis of left ventricular diastolic dysfunction(LVDD)in hypertrophic cardiomyopathy(HCM).Materials and Methods:The clinical data,echocardiography and CMR parameters of 103 patients with HCM diagnosed in Beijing Fuwai Hospital from February 2021 to August 2022 were retrospectively analyzed.According to the results of echocardiography,the patients were divided into 28 patients with LVDD group(group A)and 75 patients with no obvious LVDD group(group B).Independent sample t test,non-parametric test,Chi-square test and other statistical methods were mainly used to compare clinical baseline data,basic parameters of CMR,left ventricular strain(LVS)and LAS parameters of group A and group B,respectively.Meanwhile,logistic regression analysis was used to screen independent related factors of LVDD.Results:Patients in group A were older[median age 53.0(43.2,66.8)years],had higher rates of New York Heart Association(NYHA)Ⅲ-Ⅳ(60.7%),and higher rates of clinical symptoms such as syncope(32.1%)and sudden cardiac death(32.1%).Compared with group B,left atrial anteroposterior diameter(LAD-AP),left ventricular end-systolic volume index(ESVi),left ventricular mass index(LVMi)and the proportion of left ventricular outflow tract obstruction(LVOTO)were significantly increased in group A(P<0.05).The passive strain(εe),peak positive strain rate(SRs),early peak negative strain rate(SRe)and late peak negative strain rate(SRa)were significantly decreased(P<0.05).Multivariate logistic regression analysis showed that LVOTO[odds ratio(OR)=4.127,95%confidence interval(CI):1.488-11.450,P=0.006]and SRa(OR=4.672,95%CI:1.624-13.441,P=0.004)were independently correlated with LVDD,and SRa had high diagnostic efficacy,the area under the curve(AUC)of the receiver operator characteristic(ROC)that distinguishes LVDD is 0.717.Conclusions:CMR LAS can reflect LVDD in patients with HCM.SRa has a certain diagnostic efficacy for LVDD,which is a potential dia

关 键 词：肥厚型心肌病 应变 磁共振成像 特征追踪技术 左室舒张功能 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]