摘要
目的 采用心脏磁共振(CMR)分层应变技术评估伴或者不伴心内膜下LGE的HCM患者左心室心肌功能变化,并探究HCM患者发生心内膜下LGE的预测因素。方法 回顾性纳入2017年1月至2020年9月在昆明医科大学第一附属医院接受CMR检查的HCM患者61例,年龄、性别相匹配的健康对照组49例。依据有无心内膜下LGE,将HCM患者分为无心内膜下LGE组(G1组,n=40)和心内膜下LGE组(G2组,n=21)。采用CMR分层应变技术获取左心室心肌整体纵向应变(GLS)和心内膜下纵向应变(endo LS)。比较上述3组心脏结构、功能以及应变参数差异。采用单因素及多因素Logistic回归分析HCM患者心内膜下LGE发生的独立危险因素,并通过受试者操作特征(ROC)曲线评估其预测效能。结果 G2组GLS、endo LS较G1组和对照组显著减低(GLS:-10.57%±2.56%G2Vs.-12.53%±2.49%G1Vs.-17.35%±1.77%_(对照组),endo LS:-10.35%±2.47%G2Vs.-13.60%±2.52%G1Vs.-18.58%±1.86%对照组,均P <0.001)。多因素Logistic回归分析显示endo LS是HCM患者心内膜下LGE发生的独立危险因素(OR=1.696,P=0.001),预测心内膜下LGE发生的曲线下面积(AUC)为0.852,截断值为-11.87%,灵敏度为81.0%,特异度为85.0%。结论 CMR分层应变指标endo LS能够早期识别HCM患者心内膜下功能障碍,可能是HCM患者心内膜下LGE发生的理想预测指标。
Objective This study aims to evaluate the left ventricular myocardial function in HCM patients with or without subendocardial LGE by cardiac magnetic resonance(CMR)layer-specific strain technology and to explore the factors for predicting subendocardial LGE in HCM patients.Methods A retrospective study was conducted on 61 patients with HCM who underwent CMR imaging at the First Affiliated Hospital of Kunming Medical University from January 2017 to September 2020,with 49 healthy controls matched for age and gender.The HCM patients were divided into a group without subendocardial LGE(G1 group,n=40)and a group with subendocardial LGE(G2 group,n=21).CMR-based feature tracking was used to obtain global longitudinal strain(GLS)and endocardial longitudinal strain(endoLS)of the left ventricular myocardium.Differences in cardiac structure,function,and strain parameters among the three groups were compared.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for subendocardial LGE in HCM patients,and the predictive performance was assessed using receiver operating characteristic(ROC)curve.Results GLS and endoLS were significantly lower in G2 than those in G1 and control group(GLS:-10.57%±2.56%(G2)Vs.-12.53%±2.49%(G1)Vs.-17.35%±1.77%(controls),endoLS:-10.35%±2.47%(G2)Vs.-13.60%±2.52%(G1)Vs.-18.58%±1.86%(controls),all P<0.001).Multivariate Logistic regression analysis showed that endoLS was an independent risk factor for subendocardial LGE in HCM patients(OR=1.696,P=0.001).The area under the curve(AUC)for predicting subendocardial LGE was 0.852,the cutoff value was-11.87%,the sensitivity was 81.0%and the specificity was 85.0%.Conclusion CMR-layered strain index endoLS can identify early dysfunction of the endocardium in HCM patients,and may be an ideal predictor for the occurrence of endocardial LGE in HCM patients.
作者
高薇
陈伟
王钰
杞天付
吴灵教
李志明
赵卫
GAO Wei;CHEN Wei;WANG Yu;QI Tianfu;WU lingjiao;LI Zhiming;ZHAO Wei(Dept.of Radiology,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;Dept.of Radiology,The 1st People's Hospital of Honghe State,Mengzi Yunnan 661199;Dept.of Ultrasound,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)
出处
《昆明医科大学学报》
CAS
2024年第8期58-66,共9页
Journal of Kunming Medical University
基金
国家自然科学基金资助项目(82060312)
云南省科技厅计划基金资助项目(202301AY07000-054,202101AT070249)
云南省放射与治疗临床医学研究中心子项目(202102AA100067,20102AA100067)。
关键词
肥厚型心肌病
心内膜下LGE
分层应变
心脏磁共振
Hypertrophic cardiomyopathy
Subendocardial LGE
Layer-specific strain
Cardiac magnetic resonance
