心脏磁共振评估儿童慢性肾脏病1期早期亚临床心功能障碍

Evaluation of early subclinical cardiac dysfunction in children with stage 1 chronic kidney disease by cardiac magnetic resonance

目的:探讨心脏磁共振成像(CMR)组织追踪技术在评价儿童慢性肾脏病(CKD)1期(G1)早期左心室心功能及心肌应变中的价值和左心室早期改变与临床指标的相关性。方法:选取35例临床确诊的CKD G1儿童(CKD G1儿童组)及18名年龄、性别匹配的健康儿童(对照组)为研究对象。行3.0 T非增强CMR检查,通过图像后处理计算得到左心室心功能参数,并通过CMR组织追踪技术处理得到包括左室整体、基底段、中间段、心尖段的纵向、周向和轴向心肌峰值应力(PS);同时收集CKD G1儿童临床资料及实验室资料。比较两组儿童左心室心功能参数和心肌应变的差异,分析CKD G1儿童组左心室早期改变与临床指标的相关性。结果:CKD G1儿童组与对照组左心室射血分数(LVEF)、左心室心肌质量指数(LVLMI)、重构指数(LVCI)等心功能参数比较,差异无统计学意义(P>0.05)。CKD G1儿童组左心室整体纵向PS较对照组降低(P<0.05)。分节段分析发现,纵向PS减低主要表现在心尖段,较对照组降低(P<0.05)。双变量相关分析结果显示,CKD G1儿童同期尿蛋白定性及体质量指数(BMI)与左心室整体轴向及周向PS绝对值呈负相关(P<0.05);尿蛋白定性、心肌BMI与LVEF呈负相关(P<0.05);尿蛋白定性及持续异常时间和心肌BMI与LVCI呈正相关(P<0.05)。结论:CMR组织追踪技术能够早期评价CKD G1儿童亚临床左心室心功能障碍,表现为左心室整体纵向PS减低,并以心尖段减低为主。CKD G1早期左心室心功能障碍与尿蛋白定性、尿蛋白异常持续时间及心肌BMI可能存在一定相关性。

Objective:To study the value of cardiac magnetic resonance(CMR)tissue tracking technology in evaluating early abnormality of left ventricular in children with chronic kidney disease(CKD)stage 1(G1),and to further investigate clinical related factors of the early changes in configuration and functional parameters of left ventricular in children with CKD G1.Methods:35 children with CKD G1 and 18 healthy controls matched with age and sex were enrolled.Left ventricular function parameters and longitudinal,circumferential and axial peak stress(PS)of the whole left ventricle,basal segment,middle segment and apical segment were acquired after CMR scanning and image post-processing.Meanwhile,laboratory data of renal function of CKD G1 children were collected.Left ventricular functional parameters as well as myocardial strain between the case group and the control group were compared,and the correlation between left ventricular alterations and clinical data were analyzed.Results:There was no significant difference in cardiac function parameters such as left ventricular ejection fraction(LVEF),left ventricular myocardial mass index(LVLMI)and remodeling index(LVCI)between CKD G1 children group and control group(P>0.05).The overall longitudinal PS of left ventricle in CKD G1 group was lower than that in the control group(P<0.05).Segmental analysis showed that the longitudinal PS decreased mainly in the apical segment,which was lower than that in the control group(P<0.05).Bi-variate correlation analysis showed that proteinuria and BMI were negatively correlated with the absolute value of global radial and circumferential peak stress of left ventricle(P<0.05).There was a negative correlation between LVEF and urinary protein and BMI(P<0.05),and a positive correlation between LVCI and proteinuria,duration of proteinuria and BMI(P<0.05).Conclusion:CMR tissue tracking technique can early evaluate the subclinical left ventricular dysfunction in children with CKD G1,which is characterized by the decrease of left ventricular longitudinal PS,mainly in the apical segment.Early left ventricular dysfunction in CKD G1 may be related to the characterization of urinary protein,the duration of abnormal urinary protein and myocardial BMI.