基于磁共振特征追踪技术定量评价扩张型心肌病患者双室心肌应变功能的初步临床研究

Quantitative Assessment of Double Ventricular Strain in Patients with Dilated Cardiomyopathy using Cardiovascular Magnetic Resonance Feature Tracking Techniques: A Preliminary Clinical Study

目的基于心脏磁共振(CMR)特征组织追踪技术定量评估扩张型心肌病(DCM)患者和健康对照组左右室不同方向心肌应力值,并结合临床指标分析DCM患者相关磁共振定量参数异常的影响因素。方法对73例DCM患者及40例健康志愿者行1. 5T CMR检查,将心脏电影离线导入组织追踪应力分析后处理软件,半自动计算左右室心肌收缩峰值纵向应力(GLS)、左室周向应力(GCS)、左室径向应力(GRS)以及不同方向心肌应力率。行CMR检查前,搜集DCM患者基线临床数据以及相关血生化指标。应用独立样本t检验比较两组正态分布数据大小,卡方χ~2检验比较分类变量差异。应用Pearson相关分析两组正态分布数据的相关性,Spearman相关分析非正态分布数据的相关性。结果 DCM患者组的LVGLS、LVGCS、LVGRS及RVGLS值均低于正常对照组[LVGLS:(-4. 7±2. 5)%、(-14. 4±2. 4)%;LVGCS:(-6. 1±2. 6)%、(-21. 8±2. 3)%;LVGRS:(7. 7±4. 0)%、(39. 2±9. 0)%;RVGLS:(-9. 9±6. 5)%、(-19. 5±3. 7)%;P <0. 01];DCM患者组的LVEF、RVEF值亦低于正常对照组[LVEF:(16. 2±7. 2)%、(58. 0±5. 5)%;RVEF:(19. 9±11. 8)%、(43. 7±8. 6)%;P <0. 01]。DCM患者的血清肌钙蛋白(TNI)值与左室舒张期峰值径向应力率(LVGRSR-D)、右室收缩期峰值纵向应力率(RVGLSR-S)有相关性(P <0. 05);血清乳酸脱氢酶(LDH)值与LVGRS、LVGCS、左室收缩期峰值周向应力率(LVGCSR-S)有相关性(P <0. 05);肌酸激酶(CK)值与RVGLSR-S有相关性(P <0. 05)。结论 DCM患者左室整体纵向、径向、周向应力值及相应应力率、右室整体纵向应力值及应力率、左右室射血分数均明显低于正常对照组,提示DCM患者左右室心肌收缩功能及收缩应力值均受损。并发现DCM患者部分心肌酶谱指标与左右室部分心肌应力指标具有相关性,未来心肌损伤血液学标志物与CMR影像学标志物相互关系及其对患者临床管理的意义值得进一步研究。

Objective Dilated cardiomyopathy(DCM)can cause structural and functional changes in the left/double ventricle.The purpose of this study was to assess the double ventricular myocardial systolic strain in patients with DCM using cardiac magnetic resonance feature tracking(MR-FT)and their underlying relationships with clinical parameters.Methods We recruited 73 patients with DCM and 40 healthy volunteers to undergo CMR examinations.We then used the routine cine images and MR-FT to analyze the double ventricular myocardial global systolic strain and the strain rates.Before the CMR examination,we collected the baseline clinical and biochemical indices.Results The values of LVGLS、LVGCS、LVGRS and RVGLS were significantly lower in the DCM group than those in control group(LVGLS:(-4.7±2.5)%:(-14.4±2.4)%;LVGCS:(-6.1±2.6)%:(-21.8±2.3)%;LVGRS:(7.7±4.0)%:(39.2±9.0)%;RVGLS:(-9.9±6.5)%:(-19.5±3.7)%;P<0.01)The left and right ventricular EF values were lower in the DCM group than those in control group(LVEF:(16.2±7.2)%:(58.0±5.5)%;RVEF:(19.9±11.8)%:(43.7±8.6)%;P<0.01)In DCM group,the LVGRSR-D and RVGLSR-S values were correlated with the troponin I(TNI)levels(P<0.05);the LVGRS、LVGCS and LVGCSR-S values were associated with the Lactate dehydrogenase(LDH)levels(P<0.05);the RVGLSR-S value was correlated with the creatine kinase(CK)level(P<0.05).Conclusion Our results suggested that the left and right ventricular systolic function and systolic strain were impaired in DCM patients.We also found that there was a correlation between the myocardial enzyme spectrum and the left and right ventricular strain in patients with DCM.