摘要
目的应用心脏磁共振(cardiac magnetic resonance,CMR)心肌收缩分数(myocardial contraction fraction,MCF)评价射血分数保留的肥厚型心肌病(hypertrophic cardiomyopathy with preserved ejection fraction,HCMpEF)患者的心肌功能,并分析其与左心室形态与功能、心肌纤维化及心肌应变参数之间的关系。材料与方法回顾性分析55例HCMpEF患者和24例正常对照者资料。采用CVI 42软件测量左心室功能的相关参数,主要包括左心室射血分数(left ventricular ejection fraction,LVEF)、左心室质量指数(left ventricular mass index,LVMi)及左心室室壁最大厚度(left ventricular maximal wall thickness,LVMWT),定量评估心肌初始T1值、细胞外容积分数(extracellular volume fraction,ECV)、心肌间质容积指数及钆延迟增强(late gadolinium enhancement,LGE),及测量左心室2D整体应变参数,包括整体径向应变(global radial strain,GRS)、整体圆周应变(global circumferential strain,GCS)及整体纵向应变(global longitudinal strain,GLS)。通过左心室每搏输出量(left ventricular stroke volume,LVSV)与左心室心肌容积(left ventricular myocardial volume,LVMV)的比值计算MCF。相关性分析采用Pearson或Spearman相关系数进行检验。组间连续变量的差异采用独立样本t检验或Mann-Whitney U检验。采用受试者工作特征(receiver operating characteristic,ROC)曲线计算左心室功能指标对HCMpEF的诊断效能。结果HCMpEF组的MCF、GRS、GCS及GLS显著低于正常对照组(P<0.05),而LVMi及LVMWT显著高于正常对照组(P<0.05)。相关性分析发现MCF与LVEF(r=0.402,P=0.002)、LVMWT(r=-0.704,P=0.004)、初始T1值(r=-0.342,P=0.011)、ECV(r=-0.348,P=0.009)、GRS(r=0.642,P<0.001)、GCS(r=-0.679,P<0.001)、GLS(r=-0.675,P<0.001)存在线性相关,MCF与LVMi(r=-0.710,P<0.001)、LGE质量分数(r=-0.655,P<0.001)、心肌间质容积指数(r=-0.707,P<0.001)存在非线性相关。采用MCF、LVMi、GRS、GCS及GLS鉴别HCMpEF组及正常对照组的ROC曲线下面积分别为0.99、0.97、0.71、0.77及0.97(P<0.05)。结论CMR计算的MCF参数是评估HCMpEF患者心脏整体收缩功能的简单有效的指标,可以为临床诊治HCMpEF提供新的定量影像学标志物。
Objective:Myocardial contraction fraction(MCF)of cardiac magnetic resonance(CMR)was used to evaluate myocardial function in patients with hypertrophic cardiomyopathy with preserved ejection fraction(HCMpEF),and to explore the relationship between MCF and left ventricular morphology and function,cardiac fibrosis and myocardial strain parameters.Materials and Methods:The data of 55 HCMpEF patients and 24 normal controls were retrospectively analyzed.The CVI 42 software was used to measure the relevant parameters of left ventricular function,including left ventricular ejection fraction(LVEF),left ventricular mass index(LVMi)and left ventricular maximal wall thickness(LVMWT),and quantitatively evaluate of myocardial native T1 mapping,extracellular volume fraction(ECV),myocardial indexed interstitial volume and late gadolinium enhancement(LGE),and measure 2D global strain parameters of the left ventricle include global radial strain(GRS),global circumferential strain(GCS)and global longitudinal strain(GLS).MCF was calculated by dividing left ventricular stroke volume(LVSV)by left ventricular myocardial volume(LVMV).Pearson or Spearman analysis was used for linear or monotonic nonlinear correlations.Independent-samples t-test or Mann-Whitney U-test was performed for multiple comparisons.The receiver operating characteristic(ROC)curve calculated the diagnostic efficacy of left ventricular function parameters for HCMpEF.Results:MCF,GRS,GCS and GLS in the HCMpEF group was significantly lower than those in the control group(P<0.05),while LVMi and LVMWT were significantly higher than those in the control group(P<0.05).Correlation analysis showed that MCF correlated linearly with LVEF(r=0.402,P=0.002),LVMWT(r=-0.704,P=0.004),native T1(r=-0.342,P=0.011),ECV(r=-0.348,P=0.009),GRS(r=0.642,P<0.001),GCS(r=-0.679,P<0.001)and GLS(r=-0.675,P<0.001),MCF correlated nonlinearly with LVMi(r=-0.710,P<0.001),LGE mass fraction(r=-0.655,P<0.001),myocardial indexed interstitial volume(r=-0.707,P<0.001).The area under the ROC curve of MCF,LVMi,GRS,GCS and GLS in differentiating the HCMpEF group from the healthy control group was 0.99,0.97,0.71,0.77 and 0.97,respectively(P<0.05).Conclusions:The MCF calculated by CMR is a simple and effective index to evaluate the overall cardiac systolic function of HCMpEF patients,which can provide a new quantitative imaging marker for the clinical diagnosis and treatment of HCMpEF.
作者
蒋雨琦
束晶苇
俞宏林
张新娜
赵玲玲
杨盼盼
刘小琴
赵韧
钱银锋
余永强
李小虎
JIANG Yuqi;SHU Jingwei;YU Honglin;ZHANG Xinna;ZHAO Lingling;YANG Panpan;LIU Xiaoqin;ZHAO Ren;QIAN Yinfeng;YU Yongqiang;LI Xiaohu(Department of Radiology,Fuyang Hospital of Anhui Medical University,Fuyang 236000,China;Department of Radiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Cardiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2022年第12期38-44,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金(编号:82071897)。
关键词
肥厚型心肌病
左心室
射血分数
心肌收缩分数
应变
纤维化
磁共振成像
心脏磁共振电影成像
hypertrophic cardiomyopathy
left ventricle
ejection fraction
myocardial contraction fraction
strain
fibrosis
magnetic resonance imaging
cardiac magnetic resonance cine imaging
作者简介
通信作者:李小虎,E-mail:lixiaohu@ahmu.edu.cn。
