心脏磁共振定量技术在评估新发与长病程系统性红斑狼疮患者心肌受累的应用

Application of cardiac magnetic resonance quantitative techniques in assessing myocardial involvement in new onset and longstanding systemic lupus erythematosus patients

探讨心脏磁共振(CMR)定量技术在评估新发和长病程系统性红斑狼疮(SLE)患者心肌受累差异中的应用价值。方法前瞻性纳入2020年8月至2023年4月在安徽医科大学第一附属医院收治的14例新发和15例长病程SLE患者作为研究组,同时纳入18名年龄、性别、体表面积、体质指数匹配的健康志愿者作为对照组。收集受试者的临床基线资料、心电图及心脏磁共振结果。使用单因素方差分析或Kruskal-Wallis H检验比较3组间左心室射血分数(LVEF)、左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、心脏指数(CI)、左心室每搏输出量指数(LVSVI)、左心室质量指数(LVMI)、心肌应变、初始T 1值和T_(2)值等定量参数。结果新发和长病程SLE患者的初始T 1值[1114.50(1089.33,1150.39)ms,1085.32(1051.31,1129.75)ms]、T_(2)值[(55.9±3.4)ms,(53.3±1.5)ms]均高于健康对照组[初始T 1值1052.62(1024.75,1077.59)ms,H=17.72,P<0.001;T_(2)值(51.2±1.3)ms,F=18.70,P<0.001]。新发SLE组的T_(2)值高于长病程SLE组(P<0.05)。新发SLE组的LVEDVI[86.87(80.80,93.55)ml/m^(2)]、LVSVI[54.63(50.42,59.03)ml/m^(2)]和LVMI[48.39(41.65,53.26)g/m^(2)]均高于对照组[LVEDVI:71.11(65.80,81.28)ml/m^(2),Z=3.02,P=0.003;LVSVI:42.17(40.36,51.33)ml/m^(2),Z=2.76,P<0.006;LVMI:38.48(35.22,43.83)g/m^(2),Z=3.10,P=0.002],其LVEDVI和LVSVI较长病程SLE组[LVEDVI:73.30(69.87,84.71)ml/m^(2),Z=1.97,P=0.048;LVSVI:45.53(42.28,50.98)ml/m^(2),Z=2.34,P=0.020]也升高。结论新发SLE患者心肌受累更严重,而长病程SLE患者急性心肌损伤得到了缓解。因此,在SLE患者中早期检测心脏受累对于改善预后非常重要。

ObjectiveTo investigate the application of cardiac magnetic resonance(CMR)quantitative techniques in evaluating myocardial involvement differences between new onset and longstanding systemic lupus erythematosus(SLE)patients.MethodsFrom August 2020 to April 2023,14 new onset and 15 longstanding SLE patients treated at the First Affiliated Hospital of Anhui Medical University were prospectively included as the study group.Additionally,18 age-,gender-,body surface area-,and body mass index-matched healthy volunteers were included as the control group.Clinical baseline data,electrocardiograms,and CMR results including left ventricular ejection fraction(LVEF),left ventricular end-systolic volume index(LVESVI),left ventricular end-diastolic volume index(LVEDVI),cardiac index(CI),left ventricular stroke volume index(LVSVI),left ventricular mass index(LVMI),myocardial strain,native T_(1)values,and T_(2)values were collected.One-way analysis of variance(ANOVA)or Kruskal-Wallis H test was used to compare the quantitative parameters among the three groups.Bonferroni correction was applied for pairwise group comparisons.ResultsThe native T_(1)values[1114.50(1089.33,1150.39)ms,1085.32(1051.31,1129.75)ms]and T_(2)values[(55.9±3.4)ms,(53.3±1.5)ms]of new onset and longstanding SLE patients were higher than those of the healthy control group[native T_(1)values 1052.62(1024.75,1077.59)ms,H=17.72,P<0.001;T_(2)values(51.2±1.3)ms,F=18.70,P<0.001].The T_(2)values of the new onset SLE group was higher than that of the longstanding SLE group(P<0.05).The LVEDVI[86.87(80.80,93.55)ml/m^(2)],LVSVI[54.63(50.42,59.03)ml/m^(2)],and LVMI[48.39(41.65,53.26)g/m^(2)]of the new onset SLE group were higher than those of the control group[LVEDVI:71.11(65.80,81.28)ml/m^(2),Z=3.02,P=0.003;LVSVI:42.17(40.36,51.33)ml/m^(2),Z=2.76,P=0.006;LVMI:38.48(35.22,43.83)g/m^(2),Z=3.10,P=0.002].The LVEDVI and LVSVI of the new onset SLE group were also higher than those of the longstanding SLE group[LVEDVI:73.30(69.87,84.71)ml/m^(2),Z=1.97,P=0.048;LVSVI:45.53(42.28,50.98)ml/m^(2),Z=2.34,P=0.020].ConclusionMyocardial involvement is more severe in new onset SLE patients,whereas acute myocardial injury is alleviated in longstanding SLE patients.Therefore,early detection of cardiac involvement in SLE patients is crucial for improving prognosis.