肥厚型心肌病心肌应力及其组织学特征:心脏磁共振T1-Mapping及特征组织追踪技术研究  

Myocardial Stress and Histological Characteristics in Hypertrophic Cardiomyopathy:Study of CMR T1-Mapping and Characteristic Tissue Tracking Technique

作　　者：聂伟霞 高立 李涯 胡国迎 袁旭春 陆敏杰 NIE Wei-xia;GAO Li;LI Ya;HU Guo-ying;YUAN Xu-chun;LU Min-jie(Fuwai Hospital Chinese Academy of Medical Sciences,ShenZhen,ShenZhen 518000,Guangdong Province,China;Fuwai Hospital Chinese Academy of Medical Sciences,Beijing 100010,China)

机构地区：[1]中国医学科学院阜外医院深圳医院,广东深圳518000 [2]中国医学科学院阜外医院,北京100010

出　　处：《中国CT和MRI杂志》2024年第11期59-61,共3页Chinese Journal of CT and MRI

基　　金：院士青年英才培育基金资助(YS-2019-016)。

摘　　要：目的通过心脏磁共振T1-Mapping及特征组织追踪技术评估肥厚型心肌病心肌应力及其心肌组织特征。方法收集我院2020年8月-2021年9月40例HCM患者及心脏健康者27例分别行心脏磁共振成像(CMR)检查[包括心脏短轴位电影、两腔、三腔、四腔电影序列、增强前T1-Mapping、增强后T1-Mapping及延迟增强(LGE)],经后处理计算心肌ECV值及左室心肌应变值(包括整体周向应变、整体径向应变、整体纵向应变);将病例组、正常组Native T1、ECV值及相应左室应变值进行对比,分析其相关性。根据左室壁有无延迟强化,将病例组分为LGE(+)组和LGE(-)组,对比两组之间的NativeT1、ECV值及左室整体应变值。结果病例组NativeT1、ECV及左室整体纵向应变、径向应变高于正常组,差异具有统计学意义[NativeT1值(1295.325±58.011)ms:(1114.407±106.967)ms,P<0.001;ECV值(38.475±6.85)%:(30.815±3.114)%,P=0.002;GLS(-12.523±3.745)%:(-18.126±2.166)%,P<0.001,GRS(34.812±6.832)%:(39.500±4.410)%,P=0.009];左室整体周向应变病例组与对照组差异不具有显著统计学意义。LGE阳性组与LGE阴性组对照,左室纵向应变差异具有统计学意义;双变量相关性采用非正态分布Spearman相关分析,三者之间均为正相关关系;ROC曲线,GLS(AUC=0.909,灵敏性92.6%、特异性80.0%),NativeT1(AUC=0.887,灵敏性77.8%、特异性100%),ECV(AUC=0.851,灵敏性92.6%,特异性72.5%),GLS诊断敏感性及特异性均较高,但三者诊断效能不具有显著性差异。结论与正常人对比,肥厚型心肌病心肌应变受损,ECV升高,且以延迟强化更为显著,而且心肌应力受损程度与ECV相关。Objective To evaluate the myocardial stress and tissue characteristics of hypertrophic cardiomyopathy by CMR T1-mapping and CMR-TT.Methods 40 Patients and 27 Normal volunteers were examined by cardiac magnetic resonance imaging(CMR)[including cardiac axial,two-chamber,three-chamber,fourchamber Cine,pre-enhanced T1-Maping,post-enhanced T1-Maping and delayed gadolinium contrast enhancement(LGE)].The ECV and LV strain(including Global circumferential strain(GCS),Global radial strain(GRS)and Global longitudinal strain(GLS))were calculated.Corresponded the NativeT1,ECV and LV strain between the two groups,and analyzed the correlation.According to LGE or not,the case group were divided into LGE(+)and LGE(-),and the NativeT1,ECV and LV strain were compared between the two groups.Results NativeT1,ECV,GLS and GRS of LV in case group were significantly higher than those in normal group[NativeT1(1295.325±58.011)ms:(1114.407±106.967)ms,P<0.001;ECV(38.475±6.85)%:(30.815±3.114)%,PP0.002].GLS(-12.523±3.745)%:(-18.126±2.166)%,P<0.001GRS(34.812±6.832)%:(39.500±4.410)%,P<0.009.There was no significant difference in GCS of LV between two groups.The GLS between LGE(+)and LGE(-)groups was significant.Spearman correlation analysis,there was a positive correlation among them.ROC curve,GLS(AUC=0.909,sensitivity 92.6%,specificity 80.0%),NativeT1(AUC=0.887,sensitivity 77.8%,specificity 100%),ECV(AUC=0.851,sensitivity 92.6%,specificity 72.5%),the sensitivity and specificity of GLS were high,but the diagnostic efficacy of the three was not statistically significant.Conclusion Compared with normal volunteers,LV strain is impaired and ECV is increased in hypertrophic cardiomyopathy,LGE is more significant,and the LV strain is related to ECV.

关 键 词：肥厚型心肌病 T1-Maping NativeT1值 ECV CMR-TT GLS 

分 类 号：R542.2[医药卫生—心血管疾病]