CT心肌应变参数在肥厚型心肌病左心房功能评估与鉴别诊断中的应用

Application of myocardial strain parameters measured by CT in assessment of left atrial function and in differential diagnosis for hypertrophic cardiomyopathy

目的:探讨基于CT所获得的心肌应变参数应用于量化肥厚型心肌病(HCM)和高血压性左室肥厚(HLVH)左房功能的可行性,以及其对这2种疾病的鉴别能力,为临床提供参考。方法:收集179例冠状动脉CTA检查结果阴性的受试者,根据临床诊断结果将其分为HCM组和HLVH组。另选择90例健康人群作为健康对照组。使用后处理软件对3组的心功能参数进行量化,对比各项参数差异。采用二元logistic回归分析检验各项参数鉴别这2种疾病的能力,并绘制ROC曲线对比其诊断效能。结果:HCM组和HLVH组的左室壁最大厚度(MLVWT)、左室质量指数(LVMI)、左房前后径(LAAP)、左房最大容积(LAV_(max))和左房最小容积(LAV_(min))均明显增高(均P<0.05),左房射血分数(LAEF)、左房周向应变(LAGCS)和左房纵向应变(LAGLS)均明显降低(均P<0.05),但HCM组更显著。二元logistic回归分析表明,MLVWT、LAGCS和LAGLS组合模型的AUC为0.925,敏感度为0.98,特异度为0.74;De Long检验示该模型的AUC均显著高于MLVWT、LAGCS和LAGLS单独的AUC。结论:基于CT所获得的心肌应变参数可精确评估HCM和HLVH患者的左房功能损伤,其中以纵向应变损伤最显著,且左房功能损伤先于左室。MLVWT、LAGCS和LAGLS组合模型对HCM和HLVM的鉴别诊断能力最佳,有望为临床提供更准确的诊断手段。

Objective:To investigate the feasibility of the utilizing myocardial strain parameters derived from CT imaging to quantify left atrial function in hypertrophic cardiomyopathy(HCM)and hypertensive left ventricular hypertrophy(HLVH).To assess the diagnostic capability of the utilizing myocardial strain parameters,thereby providing clinical reference.Methods:A total of 179 subjects with negative coronary CTA findings were enrolled,and based on the clinical diagnosis,the subjects were categorized into HCM group and HLVH group.And another 90 healthy people were enrolled as the control group.Post-processing software was employed to quantify the cardiac function parameters of 3 groups,and the differences in these parameters were compared.Binary logistic regression analysis was conducted to evaluate the diagnostic efficiency of various parameters for HCM and HLVH.ROC curves were generated to compare the diagnostic efficiency.Results:Compared with the the control group,the HCM and HLVH groups showed significant increases in maximum left ventricular wall thickness(MLVWT),left ventricular mass index(LVMI),left atrial anteroposterior diameter(LAAP),left atrial maximum volume(LAV_(max))and left atrial minimum volume(LAV_(min)),and significant decreases in left atrial ejection fraction(LAEF),left atrial global circumferential strain(LAGCS)and left atrial global longitudinal strain(LAGLS)(all P<0.05),with the most pronounced changes observed in the HCM group.Binary logistic regression analysis indicated that the combined model of MLVWT,LAGCS and LAGLS yielded an AUC of 0.925,with a sensitivity of 0.98 and a specificity of 0.74,and DeLong test showed AUC of this combined model was significantly higher than that of MLVWT,LAGCS and LAGLS alone.Conclusions:Myocardial strain parameters obtained from CT imaging can be used to accurately assess left atrial functional impairment in patients with HCM and HLVH,with longitudinal strain impairment being the most significant.Additionally,left atrial functional impairment occurs earlier than left ventricle.The combined model of MLVWT,LAGCS and LAGLS exhibits the best differential diagnostic efficiency for HCM and HLVH,offering the potential for more accurate clinical diagnosis.