基于心脏磁共振特征追踪评估左心室心肌应变在判断冠心病病情和预后中的价值

Evaluation of the diagnostic and prognostic value of left ventricular myocardial strain assessed by cardiovascular magnetic resonance feature tracking in coronary heart disease

目的 探讨基于心脏磁共振特征追踪(CMR-FT)评估左心室心肌应变在判断冠心病(CHD)病情和预后中的价值。方法 回顾性选取2019年1月至2021年5月在衢州市中医医院经冠脉造影检查确诊为CHD的77例患者为CHD组,另选取同期本院体检且年龄相匹配的50名健康人为对照组,比较两组研究对象心功能参数[包括左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)]和心肌应变参数[包括整体纵向应变(GLS)、整体径向峰值应变(GPRS)、整体纵向峰值应变(GPLS)、整体周向峰值应变(GPCS)]。根据心脏超声检查结果分为节段性室壁运动(SWM)异常组23例和SWM正常组54例,比较两组患者心功能参数和心肌应变参数;进一步采用Pearson相关分析CHD患者心肌应变参数与心功能参数的相关性。根据2年随访期间是否发生主要不良心血管事件判定预后不良14例和预后良好63例,采用多因素logistic回归分析CHD预后的影响因素。结果 CHD组患者LVEDV、LVESV、GLS、GPCS、GPLS均高于对照组(均P<0.01),而LVEF、GPRS均低于对照组(均P<0.01)。SWM异常组LVEDV、LVESV、GLS、GPCS、GPLS均高于SWM正常组(均P<0.05),而LVEF、GPRS均低于SWM正常组(均P<0.05)。CHD患者GPRS与LVEDV、LVESV均呈负相关,与LVEF呈正相关,差异均有统计学意义(均P<0.01);而GLS、GPCS、GPLS与LVEDV、LVESV均呈正相关,与LVEF均呈负相关,差异均有统计学意义(均P<0.01)。年龄(OR=5.582)、LVEF(OR=0.128)、GLS(OR=5.198)、GPRS(OR=0.180)、GPCS(OR=9.930)、GPLS(OR=8.328)均是CHD患者预后的影响因素(均P<0.05)。结论 基于CMR-FT评估CHD左心室心肌应变具备可行性,心肌应变参数GLS、GPRS、GPCS、GPLS在评估CHD患者病情及预后方面均有一定价值。

Objective To investigate the value of left ventricular myocardial strain assessed by cardiovascular magnetic resonance feature tracking(CMR-FT) in evaluating the condition and prognosis of coronary heart disease(CHD). Methods A retrospective study included 77 patients diagnosed with CHD by coronary angiography in Quzhou Traditional Chinese Medicine Hospital from January 2019 to May 2021 as the CHD group, and 50 healthy individuals matched for age who underwent health check-ups during the same period as control group. Cardiac function parameters [including left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume(LVEDV) and left ventricular ejection fraction(LVEF)] and myocardial strain parameters [including global longitudinal strain(GLS), global peak radial strain(GPRS), global peak long strain(GPLS) and global peak circumferential strain(GPCS)] were compared between the two groups. According to the results of echocardiography, the patients were divided into abnormal segmental wall motion(SWM) group(23 cases) and normal SWM group(54 cases), cardiac function parameters and myocardial strain parameters were compared between the two groups. Pearson correlation method was used to analyze the relationship between myocardial strain parameters and cardiac function parameters in CHD patients. According to the occurrence of major adverse cardiovascular events during the 2-year follow-up, 14 cases with poor prognosis and63 cases with good prognosis were determined, and multivariate logistic regression was used to analyze the influencing factors of CHD prognosis. Results LVEDV, LVESV, GLS, GPCS and GPLS in CHD group were higher than those in control group(all P<0.01), while LVEF and GPRS were lower than those in control group(all P<0.01). LVEDV, LVESV,GLS, GPCS and GPLS in abnormal SWM group were higher than those in normal SWM group(all P<0.05), while LVEF and GPRS in abnormal SWM group were lower than those in normal SWM group(all P<0.05). LVEDV, LVESV, GLS, GPCS and GPLS in abnormal SWM group were higher than those in normal SWM group(all P<0.05), while LVEF and GPRS in abnormal SWM group were lower than those in normal SWM group(all P<0.05). In CHD patients, GPRS was negatively correlated with LVEDV and LVESV and positively correlated with LVEF(all P<0.01). GPCS, GPLS and GLS were positively correlated with LVEDV and LVESV and negatively correlated with LVEF(all P<0.01). Age(OR=5.582), LVEF(OR=0.128),GLS(OR=5.198), GPRS(OR=0.180), GPCS(OR=9.930), GPLS(OR=8.328) were the prognostic factors of CHD patients(all P<0.05). Conclusion Assessing left ventricular myocardial strain in CHD based on CMR-FT is feasible. Myocardial strain parameters GLS, GPRS, GPCS and GPLS have certain values in evaluating the condition and prognosis of CHD patients.