摘要
目的 采用心脏磁共振组织追踪技术(CMR-TT)探索高血压心脏病(HHD)患者左、右心室应变的特点及差异,阐明高血压对左、右心室重构的影响。方法 采用回顾性研究的方法,搜集2015年3月至2019年3月在南昌大学第二附属医院确诊为HHD的患者36例及健康志愿者20名(作为对照组),所有受检者均行CMR检查。HHD组分别根据左心室射血分数(LVEF)是否降低、左心室内径(LVD)是否扩大及心房是否受累进行亚组分析。采用CMR-TT后处理技术测定心肌整体径向应变峰值(GRPS)、整体环向应变峰值(GCPS)、整体纵向应变峰值(GLPS),对HHD各亚组分析左、右心室应变的特点。结果 HHD患者的左、右心室GRPS、GCPS、GLPS较正常组均减低,差异有统计学意义(P<0.05)。在HHD患者中,根据LVEF、左心室不同构型以及心房受累分别进行亚组分析,发现随着射血分数的减低,左心室向心性重构向离心性重构的转变,从双心房正常、仅左心房扩大,至双心房均扩大的重构过程中,左、右心室GRPS、GCPS、GLPS均呈减低趋势,且大部分组间比较差异有统计学意义(P<0.05)。对HHD组和对照组进行受试者工作特征(ROC)曲线分析发现,GLPS诊断高血压患者左、右心室重构的效能最佳,在左、右心室其截断值分别为-13.43%和-16.74%,曲线下面积(AUC)分别为0.90和0.86。结论 HHD不仅影响左心室,也会导致右心室重构,左、右心室重构存在差异性,演变进程又存在协同性,从射血分数是否保留、左心室构型、心房受累多方面能够明确双心室重构程度。磁共振心肌应变定量,尤其是纵向应变,能够为HHD心室重构提供更早、更精准的信息。
Objective Cardiac magnetic resonance tissue tracking(CMR-TT)was used to explore the characteristics and differences of left and right ventricular strain in patients with hypertensive heart disease(HHD),and to clarify the effect of hypertension on left and right ventricular remodeling.Methods Using the method of retrospective study,36 patients with HHD diagnosed in the Second Affiliated Hospital of Nanchang University from March 2015 to March 2019 were collected as HHD group.And 20 healthy volunteers in the same period were collected as the control group.All the subjects were examined by CMR.Subgroup analysis of left and right ventricular strain was performed in HHD group.Grouped according to left ventricular ejection fraction(LVEF),left ventricular diameter(LVD),or atrium area respectively.Results The GRPS,GCPS and GLPS of left and right ventricles in patients with HHD were lower than those in normal subjects,and the difference was statistically significant(P<0.05).Subgroup analysis based on left ventricular ejection fraction,left ventricular geometry and atrial involvement were performed in patients with HHD.It was found that with the decrease of ejection fraction,left ventricular concentric remodeling changed to acentric remodeling,from normal biatrium,only left atrium enlargement to biatrial enlargement,the GRPS,GCPS and GLPS of left and right ventricles all showed decreasing trends,and most of the differences between groups were statistically significant.Based on the analysis of ROC curve in HHD group and control group,it was found that GLPS was the best in the diagnosis of left and right ventricular remodeling in patients with hypertension,with cutoff values of-13.43%and-16.74%,respectively.And the area under the curve was 0.90 and0.86,respectively.Conclusion Hypertensive heart disease not only affects the left ventricle,but also leads to right ventricular remodeling.There are differences in left and right ventricular remodeling and synergy in the evolution process.The degree of bilateral ventricular remodeling can be determined from the perspectives of ejection fraction retention,left ventricular configuration and atrial involvement.MR myocardial strain quantification,especially longitudinal strain,can provide earlier and more accurate information for ventricular remodeling in hypertensive heart disease.
作者
胡梦瑶
龚良庚
喻思思
HU Mengyao;GONG Lianggeng;YU Sisi(Department of Radiology,The Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi Province 330006,P.R.China)
出处
《临床放射学杂志》
北大核心
2022年第10期1883-1888,共6页
Journal of Clinical Radiology
基金
2020年江西省卫生健康委科技计划项目(编号:20201052)
2020年江西省研究生创新专项资金基金资助项目(编号:YC2020-S127)。
