心脏MR特征追踪技术早期评价高血压性心脏病左心室亚临床功能障碍的研究

Early detection of subclinical myocardial dysfunction assessed by cardiac MR feature tracking in hypertensive heart disease patients

目的探讨心脏MR特征追踪(CMR-FT)技术在早期定量分析高血压性心脏病(HHD)左心室亚临床功能障碍中的应用价值。方法回顾性分析2018年10月至2019年11月于华中科技大学同济医学院附属同济医院诊治的高血压性心脏病伴左心室肥厚(HHD-LVH)患者16例、高血压性心脏病不伴左心室肥厚(HHD-非LVH)患者24例及年龄与性别相匹配的血压正常者24名。所有研究对象进行3.0 T CMR检查,扫描序列包括心脏电影和钆延迟增强。通过Argus后处理软件测量左心室心功能参数,主要包括左心室舒张末期容积指数(LVEDVI)、左心室质量指数(LVMI)、左心室壁最大厚度(LVMWT)及左心室质量与左心室舒张末期容积比例(M/V)。采用CVI42商业后处理软件测量左心室心肌应变指标,包括整体径向、圆周、长轴应变(GRS、GCS、GLS),收缩期径向、圆周、长轴应变率峰值(SRSR_(peak)、SCSR_(peak)、SLSR_(peak)),舒张期径向、圆周、长轴应变率峰值(DRSR_(peak)、DCSR_(peak)、DLSR_(peak))。以单因素方差分析(scheffe校正)或Kruskal-Wallis检验比较3组组间连续性变量的差异。以Pearson或Spearman相关系数进行相关性分析。结果HHD-LVH组的LVEDVI、LVMI、LVMWT及M/V均显著高于HHD-非LVH组和对照组(P<0.05)。与对照组比较,HHD-LVH组的GRS、GCS和GLS减低,HHD-LVH组和HHD-非LVH组的DRSR_(peak)、DCSR_(peak)和DLSR_(peak)均减低,差异均具有统计学意义(P<0.05)。相关性分析发现LVMI与GRS(r=-0.384,P=0.002)、GCS(r=0.392,P=0.001)、GLS(r=0.491,P<0.0001)存在线性相关,LVMWT与GRS(r=-0.362,P=0.003)、GCS(r=0.384,P=0.002)、GLS(r=0.422,P=0.001)存在非线性相关,LVEDVI与GRS(r=-0.295,P=0.018)、GCS(r=0.264,P=0.035)存在非线性相关。结论CMR-FT技术测量的心肌应变指标可作为早期评价HHD患者左心室亚临床功能障碍的影像学参数,并有助于指导早期干预治疗,改善心室重塑。

Objective To evaluate the value of cardiac MR feature tracking(CMR-FT)on the early assessment of left ventricular subclinical myocardial dysfunction in patients of hypertensive heart disease(HHD).Methods From October 2018 to November 2019,16 HHD patients with left ventricular hypertrophy(HHD-LVH),24 HHD patients without left ventricular hypertrophy(HHD-nonLVH)and 24 age-and gender-matched normotensive controls who underwent 3.0 T CMR examination were retrospectively enrolled.Imaging protocol included cine sequence and late gadolinium enhancement.Left ventricular function variables were measured using Argus software,mainly including left ventricular end-diastolic volume index(LVEDVI),left ventricular mass index(LVMI),left ventricular maximal wall thickness(LVMWT),the ratio of left ventricular mass to left ventricular end-diastolic volume(M/V).CMR-FT was performed using commercial software CVI^(42),with parameters including global radial,circumferential,longitudinal strains(GRS,GCS,GLS),peak systolic radial,circumferential,longitudinal strain rate(SRSR_(peak),SCSR_(peak),SLSR_(peak))and peak diastolic radial,circumferential,longitudinal strain rate(DRSR_(peak),DCSR_(peak),DLSR_(peak))derived.One-way analysis of variance with scheffe correction or Kruskal-Wallis test was performed for multiple comparisons.Pearson or Spearman analysis was used for linear or monotonic nonlinear correlations.Results HHD-LVH group had higher LVEDVI,LVMI,LVMWT and M/V than HHD-nonLVH group and control group(P<0.05).Compared with control group,GRS,GCS and GLS were statistically impaired in HHD-LVH group,and DRSR peak,DCSR_(peak) and DLSR_(peak) were statistically reduced in HHD-LVH group and HHD-nonLVH group(all P<0.05).Correlation analysis showed that LVMI correlated linearly with GRS(r=-0.384,P=0.002),GCS(r=0.392,P=0.001)and GLS(r=0.491,P<0.0001),LVMWT correlated nonlinearly with GRS(r=-0.362,P=0.003),GCS(r=0.384,P=0.002)and GLS(r=0.422,P=0.001),LVEDVI correlated nonlinearly with GRS(r=-0.295,P=0.018)and GCS(r=0.264,P=0.035).Conclusion CMR-FT derived left ventricular strain parameters could be served as early indicators for the assessment of subclinical myocardial dysfunction in HHD patients,which have great potential in guiding appropriate intervention therapy and improving cardiac remodeling.