基于CMR左室长轴应变预测多发性骨髓瘤继发心肌淀粉样变LGE的临床价值

Clinical value of CMR left ventricular long-axis strain in predicting LGE in cardiac amyloidosis secondary to multiple myeloma

目的 探讨心脏磁共振(cardiac magnetic resonance, CMR)左室长轴应变(left ventricular long-axis strain,LV LAS)对多发性骨髓瘤(multiple myeloma, MM)继发心肌淀粉样变(cardiac amyloidosis, CA)患者延迟钆增强(late gadolinium enhancement, LGE)的预测价值。材料与方法 回顾性分析33例MM继发CA患者及29例对照组临床资料和CMR参数。根据有无异常强化将MM继发CA患者分为LGE(+)组和LGE(-)组,采用单因素logistic回归与受试者工作特征(receiver operating characteristic, ROC)曲线分析CMR参数对MM继发CA患者LGE的预测价值。采用组内相关系数(intra-class correlation coefficient, ICC)分析CMR左室(left ventricular, LV)长轴应变观察者间和观察者内的一致性。结果 MM继发CA患者多为老年男性(占72.7%),临床症状复杂多样,患者心电图等辅助检查结果多异常。同一医师两次测量以及不同医师之间测量所得的LV质量指数(mass index, MI)及LV LAS一致性好(ICC范围为0.906~0.982)。与LGE(-)组比较,LGE(+)组患者左室射血分数(left ventricular ejection fraction, LVEF)、心脏指数(cardiac index, CI)更低,LVMI更大,LV LAS受损程度更严重(P均<0.05)。单因素logistic回归分析显示,LVEF、CI、LVMI、LV LAS预测LGE阳性的差异均有统计学意义(P<0.05)。ROC曲线分析显示,LV LAS<-14.3%[曲线下面积(area under the curve, AUC):0.909,敏感度:90.5%,特异度:75.0%,95%CI:0.756~0.981]和LVMI>83.9 g/m^(2)(AUC:0.877,敏感度:71.4%,特异度:100.0%,95%CI:0.716~0.965)预测CA患者LGE阳性效能佳。结论 LV LAS不仅能定量评估继发CA患者左室功能受损严重程度,且对LGE具有预测价值,能为肾功能不全患者心脏受累进行早期临床定量评估和预防严重不良事件提供决策。

Objective:To investigate the predictive value of left ventricular long-axis strain(LV LAS) with cardiac magnetic resonance(CMR) in patients with cardiac amyloidosis secondary to multiple myeloma(MM) with late gadolinium enhancement(LGE).Materials and Methods:The clinical data and CMR parameters of 33 patients with CA secondary to MM and 29 control groups were retrospectively analyzed.CA patients secondary to MM were divided into LGE(+) group and LGE(-) group according to the presence or absence of abnormal enhancement,univariate logistic regression and receiver operating characteristic(ROC) curve was used to analyze the predictive value of CMR parameters for LGE in CA patients secondary to MM.The intra-class correlation coefficient(ICC) test was used to analyze the differences between and within observers of the left ventricular long axis strain(LV LAS) of CMR.Results:Most patients with CA secondary to MM are elderly men(accounting for 72.7%),with complex clinical symptoms and abnormal results such as electrocardiograms.Compared with the LGE(-) group,patients with LGE(+) had lower left ventricular ejection fraction(LVEF),cardiac index(CI),greater left ventricular mass index(LVMI),and more severe LV LAS damage(P<0.05).Univariate logistic regression analysis showed that there were statistically significant differences in the prediction of LGE positivity by LVEF,CI,LVMI and LV LAS(P<0.05).ROC analysis showed that LV LAS<-14.3% [area under the curve(AUC):0.909,sensitivity:90.5%,specificity:75.0%,95% CI:0.756-0.981] and LVMI>83.9 g/m^(2)(AUC:0.877,sensitivity:71.4%,specificity:100.0%,95% CI:0.716-0.965)predicted good LGE positive efficacy in CA patients.Conclusions:LV LAS can not only quantitatively assess the severity impaired of left ventricular function in CA patients secondary to MM,but also has predictive value for LGE.It can provide decision-making for early clinical quantitative assessment of cardiac involvement and prevention of serious adverse events in patients with renal insufficiency.