CMR特征追踪技术在帕金森病患者左心评估中的价值

Value of the CMR feature tracking technique in the assessment of the left heart in patients with Parkinson's disease

目的应用心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术评估帕金森病(Parkinson’s disease,PD)患者的左心结构和功能,并探讨影响其结构和功能的因素。材料与方法前瞻性纳入2022年3月至2023年8月于四川大学华西医院就诊的PD患者(PD组)39例,同期招募年龄及性别匹配的健康对照者(对照组)34例,均完成常规心脏磁共振(cardiac magnetic resonance,CMR)检查。使用专业后处理软件CVI42分别获得左心室及左心房的常规心功能及心肌应变参数。左心室参数包括:收缩末期容积、舒张末期容积、心肌质量、射血分数、整体周向、径向及纵向应变。左心房参数包括:储备期、导管期及泵血期的射血分数、容积、应变及应变率。采用独立样本t检验或Mann-Whitney U检验分析各参数的组间差异。采用Pearson或Spearman相关系数模型分析常规心功能及应变参数与运动功能及自主神经功能的相关性。结果PD组相较于对照组,左室射血分数[(62.01±6.59)%vs.(64.84±4.70)%]及整体的纵向应变[(-17.25±1.57)%vs.(-18.28±1.99)%]均较低(P均<0.05)。PD组相较于对照组,左心室收缩末期容积(left ventricular end-systolic volume,LVESV)[(51.17±16.56)mL vs.(42.56±9.06)mL]、LVESV指数(LVESV index,LVESVi)[(30.44±8.00)mL·m^(-2)vs.(25.56±5.14)m L·m^(-2)]、左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVi)[(79.31±10.76)m L·m^(-2)vs.(72.97±12.51)mL·m^(-2)]及左心室心肌质量指数(left ventricular mass index,LV massi)[41.82(33.11,47.77)g·m^(-2)vs.33.71(32.27,38.78)g·m^(-2)]均较高(P<0.05)。PD组的左心房储备期、导管期及泵血期的射血分数、应变及应变率较对照组明显减低(P均<0.05)。相关性分析显示,左心房储备期应变及应变率与统一帕金森评定量表Ⅲ(Unified Parkinson’s Disease Rating ScaleⅢ,UPDRSⅢ)评分呈负相关(r=-0.409、-0.355,P<0.05)。左心房导管期射血分数、应变与UPDRSⅢ评分呈负相关(r=-0.326、-0.482,P<0.05)、应变率与UPDRSⅢ评分呈正相关(r=0.417,P=0.008)。左心房储备期应变、应变率与自主神经症状自评量表(The Scales for Outcomes in Parkinson’s Disease-Autonomic,SCOPA-AUT)评分呈负相关(r=-0.535、-0.319,P均<0.05)。左心房导管期应变与SCOPA-AUT评分呈负相关(r=-0.319,P=0.048),应变率与SCOPA-AUT评分呈正相关(r=0.359,P=0.025)。左心房泵血期应变与SCOPA-AUT呈负相关(r=-0.342,P=0.033)。结论CMR-FT获得的应变及应变率参数可早期评估PD患者的心功能受损程度。PD患者左室收缩功能及左心房储备、导管、泵功能受损;左心房储备功能及导管功能与运动功能障碍及自主神经功能障碍的严重程度相关。

Objective:To evaluate left ventricular structure and function in patients with Parkinson's disease(PD)by cardiac magnetic resonance feature tracking(CMR-FT).The factors affecting its structure and function were also investigated.Materials and Methods:Prospective inclusion of 39 PD patients(PD group)who visited West China Hospital of Sichuan University from March 2022 to August 2023,and 34 age-and gender-matched healthy controls(control group)recruited during the same period,all completed routine cardiac magnetic resonance(CMR)examinations.CVI42 software was used to obtain the conventional cardiac function and myocardial strain parameters of the left ventricle and left atrium.Left ventricular parameters included left ventricular end-systolic volume,end-diastolic volume,myocardial mass,ejection fraction,global circumferential strain,radial strain and longitudinal strain.Left atrium parameters included ejection fraction,volume,strain and strain rate during the left atrium reserve phase,catheter phase and pumping phase.Independent sample t test or Mann-Whitney U test was used to analyze the differences between groups in each parameter.Pearson or Spearman correlation coefficient model was used to analyze the correlation of conventional cardiac function and strain parameters with motor function and autonomic nerve function.Results:Left ventricular ejection fraction[(62.01±6.59)%vs.(64.84±4.70)%]and global longitudinal strain[(−17.25±1.57)%vs.(−18.28±1.99)%]in the PD group were lower than those in the control group,and the differences were statistically significant(all P<0.05).Left ventricular end-systolic volume(LVESV)[(51.17±16.56)mL vs.(42.56±9.06)mL],LVESV index(LVESVi)[(30.44±8.00)mL·m^(-2) vs.(25.56±5.14)mL·m^(-2)]、,left ventricular end-diastolic volume index(LVEDVi)[(79.31±10.76)mL·m^(-2) vs.(72.97±12.51)mL·m^(-2)]and left ventricular mass index(LV massi)[41.82(33.11,47.77)g·m^(-2) vs.33.71(32.27,38.78)g·m^(-2)]in the PD group were higher than those in the control group,and the difference was statistically significant(P<0.05).Left atrial ejection fraction,strain and strain rate during reserve,catheter and pump phases were significantly lower in the PD group than in the control group(all P<0.05).Correlation analysis showed that the left atrial reserve strain and strain rate were negatively correlated with the unified Parkinson's disease rating scaleⅢ(UPDRSⅢ)score(r=−0.409,−0.355,P<0.05).Left atrial ejection fraction and strain during the catheter phase were negatively correlated with UPDRSⅢscore(r=−0.326,−0.482,P<0.05),and strain rate was positively correlated with UPDRSⅢscore(r=0.417,P=0.008).The left atrial reserve strain and strain rate were negatively correlated with the scores of the scales for outcomes in Parkinson's disease-autonomic(SCOPA-AUT)(r=−0.535,−0.319;All P<0.05).The left atrial catheterization strain was negatively correlated with SCOPA-AUT score(r=−0.319,P=0.048),and strain rate was positively correlated with SCOPA-AUT score(r=0.359,P=0.025).The left atrial strain during pumping was negatively correlated with SCOPA-AUT(r=−0.342,P=0.033).Conclusions:The strain and strain rate parameters obtained from CMR-FT can early assess the degree of cardiac dysfunction in PD patients.Left ventricular systolic function and left atrial reserve,catheter and pump function are impaired in PD patients.Left atrial reserve function and catheter function are related to the severity of motor dysfunction and autonomic dysfunction.