T1mapping成像联合左心房应变在鉴别心肌淀粉样变性和肥厚型心肌病中的价值

Value of T1mapping imaging combined with left atrial strain in differentiating cardiac amyloidosis from hypertrophic cardiomyopathy

目的研究T1mapping成像联合左心房特征性组织追踪技术在鉴别心肌淀粉样变性(cardiac amyloidosis,CA)和肥厚型心肌病(hypertrophic cardiomyopathy,HCM)的应用。方法回顾性分析2021年1月~2023年11月于哈尔滨医科大学附属第一医院接受1.5 T和3.0 T心脏磁共振检查的80例患者,对左心室整体心肌T1值进行测量,使用标准化T1z-score作为评估指标,以克服不同厂商和磁场强度的影响。采用特征性组织追踪技术测量左心房应变,对不同时相的左心房功能进行分析。结果对32例CA患者、48例HCM患者和30例健康受试者进行分析。在1.5 T和3.0 T中,CA组左心室心肌初始T1值明显高于HCM组和对照组(P<0.001)。CA组和HCM组的T1z-score值分别为4.8±2.2和3.4±1.9(P<0.001)。心肌应变分析显示,与HCM组和健康对照组比较,CA组的应变明显降低(P<0.05)。DeLong检验显示Es的曲线下面积(area under curve,AUC)为0.884。T1z-score和Es的组合模型对CA和HCM的鉴别能力更强,AUC更高(0.914),敏感性为95%,特异性为74.8%(P<0.05)。结论T1mapping结合左心房存储功能(Εs)可有效区分CA和HCM,为心肌肥厚性疾病的病因诊断和治疗提供新的见解。

Objective To explore non-contrast enhanced cardiac magnetic resonance T1 mapping and left atrial feature tracking techniques to distinguish cardiac amyloidosis(CA)from hypertrophic cardiomyopathy(HCM).Methods A retrospective analysis was conducted on 80 patients who underwent cardiac magnetic resonance examinations from January 2021 to November 2023 at 1.5 T and 3.0 T systems in The First Affiliated Hospital of Harbin Medical University.Measurements of global left ventricular myocardial T1 values were performed,a standard-ized T1 z-score used as an assessment metric to overcome the effects of various manufacturers and field strengths.Left atrial strain was measured with feature tracking techniques.Left atrial function at different time periods were analyzed.Results A total of 32 CA patients,48 HCM patients,and 30 healthy subjects were analyzed.For both 1.5 T and 3.0 T systems,the overall T1 values of LV myocardium was significantly higher in the CA group compared with the HCM and control groups(P<0.001).T1z-scores in the CA and HCM groups were 4.8±2.2 and 3.4±1.9,respectively(P<0.001).Myocardial strain analysis showed that strain was significantly lower in the CA group when compared with the HCM and healthy control groups(P<0.05).The DeLong’s test showed that the area under curve(AUC)of Es(AUC=0.884)was the highest.A combination model including T1z-score and Es had an improved ability to discriminate CA and HCM with a higher AUC=0.914,with a sensitivity of 95%and a specificity of 74.8%(P<0.05).Conclusion T1 mapping combined with left atrial reservoir function(Es)could effectively distinguish CA from HCM,and provide new insights for the diagnosis of the etiology and treatment of cardiac hypertrophic diseases.