心脏磁共振组织追踪技术定量评价心肌运动参数在肥厚型心肌病心源性猝死风险评估中的应用价值

The application value of quantitative evaluation of myocardial motion parameters using cardiac magnetic resonance tissue tracking technology in the risk assessment of sudden cardiac death in hypertrophic cardiomyopathy

目的:探讨心脏磁共振组织追踪技术定量评价心肌运动参数在肥厚型心肌病(HCM)心源性猝死(SCD)风险评估中的应用价值。方法:纳入2018年1月-2023年6月在云南省第一人民医院住院的151例HCM患者,应用2014年欧洲心脏病学会(ESC)指南的HCM-SCD风险计算器将上述患者分为低危组(SCD风险≤4%)、中危组(4%6%)。对比三组患者的临床资料、晚期钆增强(LGE)所占总心肌的百分比(LGE%)及特征追踪参数,分析特征追踪参数与LGE%和SCD的相关性以及特征追踪参数对SCD的预测效能。结果:151名患者中,平均随访时间39.52个月(6.09~68.17个月),共发生53例SCD事件。随着SCD风险评分的增加,三组患者的NT-proBNP、cTnI和NYHAⅢ/Ⅳ级患者比率明显增加(P<0.05)。在三组患者中,NVST、心源性猝死家族史、舒张期左心室最大室壁厚度、左心房大小和年龄这5类心血管危险因素有显著差异(P均<0.05)。三组患者延迟增强的心肌质量和占比有显著差异(P<0.05),高危组患者的LGE质量和LGE%较大,其中部分患者呈广泛LGE阳性(LGE%>15%)。心肌的特征追踪参数GRS和GRSR、GLS和GLSR、GCS和GCSR在三组间差异具有统计学意义(P均<0.05)。相关性分析显示,SCD风险分别与GRS和GRSR、GLS和GLSR、GCS和GCSR呈负相关,LGE质量及LGE%分别与GRS和GRSR、GLS和GLSR、GCS和GCSR呈负相关。ROC曲线显示GRS对HCM患者SCD的预测性更好,AUC值为0.770(95%CI:0.696~0.843),GRS<24.55%在调整混杂因素后仍与SCD独立相关(调整后的OR为5.57,95%CI:3.191~22.13,P=0.004)。结论:LGE、心肌整体应变能力和SCD风险三者互为相关,SCD风险与心肌微观运动各项参数密切相关,尤其是GRS与SCD风险以及LGE%有显著的相关性,GRS能更早、更好地预测HCM患者SCD的发生。

Objective:To explore the application value of quantitative evaluation of myocardial motion parameters using cardiac magnetic resonance tissue tracking technology in the risk assessment of sudden cardiac death(SCD)in hypertrophic cardiomyopathy(HCM).Methods:A total of 151 HCM patients who were hospitalized in the First People's Hospital of Yunnan Province from January 2018 to June 2023 were selected and divided into low-risk group(SCD risk≤4%),intermediate-risk group(4%<SCD risk≤6%),and high-risk group(SCD risk>6%)using the HCM-SCD risk calculator of the 2014 European Society of Cardiology(ESC)guidelines.The clinical data,LGE%and feature tracking parameters of the three groups were compared,and the correlation between feature tracking parameters and LGE%and SCD and the predictive performance of feature tracking parameters on SCD were analyzed.Results:Among the 151 consecutive patients,the mean follow-up time was 39.52 months(68.17 months to 6.09 months),and a total of 53 SCD events occurred.With the increase of SCD risk scores,the ratios of NT-proBNP,cTnI and NYHA gradeⅢ/Ⅳpatients in the three groups increased significantly(P<0.05).Among the three groups,there were significant differences in five types of cardiovascular risk factors:NVST,family history of sudden cardiac death,diastolic left ventricular maximal wall thickness,left atrial size,and age(P<0.05).There were significant differences in myocardial mass and proportion between the three groups(P<0.05).The LGE quality and LGE%of patients in the high-risk group were larger,and some of them were extensively LGE-positive(LGE%>15%).There were statistically significant differences in myocardial motion parameters such as global peak radial strain(GRS),global systole radial strain rate(GRSR),global peak longitudinal strain(GLS),global systole longitudinal strain rate(GLSR),global peak circumferential strain(GCS)and global systole circumferential strain rate(GCSR)among the three groups(P<0.05).Correlation analysis shows that the risk of SCD was significantly negatively correlated with GRS and GRSR,GLS and GLSR,GCS and GCSR,respectively;while the quality of LGE and LGE%were significantly positively correlated with GRS and GRSR,GLS and GLSR,GCS and GCSR,respectively.The ROC curves showed that GRS had better predictive ability for SCD in HCM patients,with an AUC value of 0.770(95%confidence interval 0.696 to 0.843),and an overall radial peak strain of<24.55%was still independently associated with SCD after adjusting for confounding factors(adjusted OR 5.57,95%CI 3.191~22.13,P=0.004).Conclusion:LGE,overall myocardial strain capacity and SCD risk are interrelated,and SCD risk is closely related to various parameters of myocardial micro motion.The risk of SCD is closely related to various parameters of myocardial micro motion,especially GRS,which is significantly correlated with the risk of SCD and LGE%.GRS can predict the occurrence of SCD in HCM patients earlier and better.