心脏磁共振成像心肌特征追踪应变分析在合并糖尿病的射血分数保留的心力衰竭患者危险分层中的价值  

Clinical Value of Cardiac Magnetic Resonance Feature-tracking Strain Analysis in Risk Stratification of Diabetic Heart Failure With Preserved Ejection Fraction

作　　者：杨文静 朱乐怡 吴伟春 张华莹 徐晶[1] 周笛 田钊鑫 蒋梦迪 王艺宁 尹刚 赵新湘[2] 赵世华 陆敏杰 YANG Wenjing;ZHU Leyi;WU Weichun;ZHANG Huaying;XU Jing;ZHOU Di;TIAN Zhaoxin;JIANG Mengdi;WANG Yining;YIN Gang;ZHAO Xinxiang;ZHAO Shihua;LU Minjie(Department of Magnetic Resonance Imaging,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Radiology Department,The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Key Laboratory of Cardiovascular Imaging(Cultivation),Chinese Academy of Medical Sciences,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,北京100037 [2]昆明医科大学第二附属医院放射科,昆明650101 [3]中国医学科学院、心血管影像重点实验室(培育),北京100037

出　　处：《中国循环杂志》2025年第3期246-253,共8页Chinese Circulation Journal

基　　金：国家自然科学基金(82471973);北京市自然科学基金(7242110);中央高水平医院临床科研业务费(2022-GSP-QZ-5);首都卫生发展科研专项(CFH 2020-2-4034);云南省科技平台与人才项目(202305AF150033)。

摘　　要：目的:探讨心脏磁共振成像(CMR)心肌特征追踪应变分析在合并糖尿病的射血分数保留的心力衰竭(HFpEF)患者危险分层中的价值。方法:回顾性纳入2012年1月至2018年12月在中国医学科学院阜外医院接受CMR检查的合并糖尿病的HFp EF患者215例。通过CMR心肌特征追踪技术计算出心肌应变参数,根据随访期间是否发生终点事件(包括全因死亡和心力衰竭住院)将患者分为事件组和无事件组。采用多因素Cox回归分析影响患者预后的相关危险因素。并分析合并高血压和(或)肥胖对合并糖尿病的HFp EF患者的预后影响,以及是否影响CMR心肌特征追踪应变的预后作用。结果:平均随访(7.1±1.8)年期间,共93例(43.3%)患者发生终点事件(事件组),其中全因死亡28例,心力衰竭住院65例。与无事件组(n=122)比,事件组左心室射血分数显著降低,钆延迟增强(LGE)阳性率、LGE质量及LGE质量百分比显著升高,整体纵向应变(GLS)、整体周向应变、整体径向应变、收缩期纵向峰值应率显著降低(P均<0.05);无论是否合并高血压或肥胖,事件组左心室GLS均显著低于无事件组(P<0.05)。多因素Cox回归分析结果显示,估算肾小球滤过率(HR=0.983,95%CI:0.972~0.993,P=0.001)、左心房最大容积指数(HR=1.015,95%CI:1.005~1.026,P=0.004)和GLS(HR=1.142,95%CI:1.060~1.231,P<0.001)为合并糖尿病的HFpEF患者不良预后的独立危险因素。校正后的N末端B型利钠肽原无独立预测价值。受试者工作特征(ROC)曲线分析显示,GLS预测结局的最佳界值为-14.09%。Kaplan-Meier生存曲线显示,在有无合并高血压或肥胖的患者中,与GLS≤-14.09%患者相比,GLS>-14.09%患者的无事件生存率均更低(P均<0.05)。结论:CMR心肌特征追踪应变分析得到的GLS是合并糖尿病的HFpEF患者不良预后的独立预测因子,且其预测不良结局的能力不受是否合并高血压和肥胖的影响,具有重要的独立危险分层价值。Objectives:To investigate the clinical value of cardiac magnetic resonance imaging(CMR)feature-tracking strain analysis in risk stratification of diabetic heart failure with preserved ejection fraction(HFpEF).Methods:In this retrospective study,a total of 215 patients with diabetic HFpEF who underwent CMR at Chinese Academy of Medical Sciences Fuwai Hospital from January 2012 to December 2018 were included.Myocardial strain parameters were calculated using CMR feature-tracking technology.Patients were followed up by medical records or telephone calls.Composite endpoint event,all-cause death or heart failure hospitalization during follow-up were recorded.Patients were divided into event group and event-free group.Univariable and multivariable Cox proportional hazard regression analyses were performed to determine the risk factors for the outcomes in diabetic HFpEF.The effects of hypertension and obesity on the prognosis of diabetic HFpEF patients and whether they affect the prognostic value of CMR feature-tracking strain analysis were also analyzed.Results:During a follow-up of(7.1±1.8)years,93(43.3%)patients had endpoint events(event group),including 28 allcause deaths and 65 heart failure hospitalization.Compared with the event-free group(n=122),patients in the event group had significantly lower left ventricular ejection fraction,higher prevalence and extent of late gadolinium enhancement,and significantly reduced global longitudinal strain(GLS),global circumferential strain,global radial strain,and global systolic longitudinal strain rate(all P<0.05).The absolute GLS value was significantly lower in event group than in event-free group,regardless of the presence of hypertension and obesity.Multivariate Cox regression analysis showed that estimated glomerular filtration rate(HR=0.983,95%CI:0.972-0.993,P=0.001),left atrial volume index(HR=1.015,95%CI:1.005-1.026,P=0.004),and GLS(HR=1.142,95%CI:1.060-1.231,P<0.001)were independent risk factors for adverse cardiovascular events in diabetic HFpEF patients.However,

关 键 词：糖尿病 射血分数保留的心力衰竭 心脏磁共振成像 特征追踪应变分析 预后分析 

分 类 号：R54[医药卫生—心血管疾病]