目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic resonance,CMR)在评估PH-LHF患者中的应用价值.材料与方法回顾性分析2018年9月至2020年9月期间215例确诊为左心衰(left heart failure,LHF)患者的临床和CMR参数,根据心脏超声测量的收缩期肺动脉压将患者分为两组,即LHF组(n=129)和PH-LHF组(n=86).比较两组的基线资料和CMR参数包括心血管形态参数、心室容积功能参数以及心室心房应变参数.通过单因素及多因素logistic回归分析CMR参数中PH-LHF的独立预测因子,并绘制受试者工作特征(receiver operating characteristics,ROC)曲线评估CMR参数的诊断价值.结果PH-LHF患者组左右心室舒张末期容积指数、收缩末期容积指数、右心室心肌质量指数、室间隔角、左心房最大直径及面积、初始T1值均高于LHF组,而左右心室射血分数、右心室每搏输出量指数、右心室心脏指数低于LHF组.PH-LHF组左心室整体纵向应变、整体周向应变以及应变率、右心室整体周向应变、左心房主动应变、被动应变、总应变均不同程度下降.多因素logistic回归分析显示CMR参数中右心室射血分数,左心室整体周向应变,左心房主动应变和左心房最大直径是PH-LHF的独立预测因子.ROC曲线分析结果显示临床模型、CMR模型、联合模型诊断PH-LHF的AUC值分别为0.773、0.777、0.828,并且DeLong检验显示当加入CMR参数后,临床模型诊断效能提升(0.773 vs.0.828,P<0.05).结论基于CMR-FT技术的心肌应变参数可以定量评估心室心房应变,反映PH-LHF患者的心肌功能以及运动情况,多参数CMR在诊断评估LHF是否合并PH中具有较好的临床增益价值.
Value of cardiac magnetic resonance feature tracking in the evaluation of patients with pulmonary hypertension due to left heart failure
Objective: To quantitatively evaluate the myocardial strain by cardiac magnetic resonance feature tracking (CMR-FT) and investigate the value of cardiac magnetic resonance (CMR) parameters of patients with pulmonary hypertension due to left heart failure (PH-LHF). Materials and Methods: The clinical and CMR data of 215 patients with left heart failure (LHF) hospitalized between September 2018 and September 2020 were retrospectively analyzed, and they were divided into two groups, 129 patients with LHF and 86 patients with PH-LHF according to systolic pulmonary artery pressure (sPAP) measured by echocardiography. The baseline data and CMR parameters, including biventricular related volumetric and functional parameters, structural parameters and myocardial strain parameters were statistically analyzed. Univariate and multivariate logistic regression analysis were used to analyze the independent predictors of PH-LHF, and receiver operating characteristics (ROC) curves were plotted to evaluate the diagnostic value of CMR parameters. Results: In patients with PH-LHF, left ventricular (LV) and right ventricular (RV) end diastolic volume index (EDVI), end systolic volume index (ESVI), right ventricular myocardial mass index (RVMMI), ventricular septal angle as well as left atrial structural parameters, including maximum of left atrial diameter (LADmax) and maximum of left atrial area (LA-amax) were higher than those in patients with LHF, while LV and RV ejection fraction (EF), right ventricular stroke volume index (RVSVI), right ventricular cardiac index (RVCI) were lower than those in patiets with LHF. LV global longitudinal strain (GLS), global circumferential strain (GCS) and the corresponding rate, RV GCS, left atrial active strain (εa), left atrial passive strain (εe), left atrial total strain (εs) were all decreased in patients with PH-LHF. Multivariate logistic regression analysis showed that RVEF, LV GCS, εa and LADmax were independent predictors of PH-LHF. ROC analysis showed that the AUC values of the clinical model, CMR model and combined model were 0.773, 0.777 and 0.828, respectively. The DeLong test showed that the diagnostic performance of the clinical model was improved after the addition of CMR parameters (0.773 vs. 0.828, P<0.05). Conclusions: CMR-FT can quantitatively evaluate biventricular and left atrial strain, and reflect myocardial function in patients with PH-LHF. CMR has a certain clinical value in the assessment of patients with PH-LHF.
left heart failurepulmonry hypertensiondiagnostic valuecardiac magnetic resonance feature trackingleft ventricular strainleft atrial strainmagnetic resonance imaging
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