Cardiac magnetic resonance evaluation of myocardial tissue characterization of different left ventricular phenotypes in patients with chronic kidney disease
Objective:To analyze the myocardial strain,native T1 and T2 values of different left ventricular phenotypes in chronic kidney disease (CKD) patients by cardiac magnetic resonance (CMR),and to investigate the myocardial tissue characterization of different left ventricular phenotypes. Materials and Methods:Prospective inclusion of 114 CKD patients and 30 age-and gender-matched healthy controls (control group). The scanning sequences included cardiac cine,T1 mapping and T2 mapping sequences. According to the left ventricular remodeling index (LVRI) and left ventricular mass index (LVMI),CKD patients were divided into the following four subgroups:normal geometry (n=43),concentric remodeling (n=22),concentric left ventricular hypertrophy (LVH) (n=20),and eccentric LVH (n=29). Cardiac post-processing software CVI 42 was used to measure left ventricular myocardial strain and strain rate,including global circumferential,radial and longitudinal strain,systolic global circumferential,radial and longitudinal strain rate,diastolic global circumferential,radial and longitudinal strain rate. Native T1 and T2 values were also measured. The myocardial tissue characterization of different left ventricular phenotypes was investigated. Univariate and multivariate linear regression analyses were used to explore the relationship between myocardial tissue characterization and physiological variables. Results:Except for global circumferential strain[−18.40％ (3.30％) vs. −19.71％±1.66％,P=0.063]and global radial strain (30.63％±7.03％ vs. 34.07％±4.61％,P=0.324) in normal geometry group,other myocardial strain parameters in CKD patients were significantly lower than those in control group (all P<0.05). Strain analysis showed that the lowest global radial strain (22.02％±8.31％) was found in the eccentric LVH group. The lowest global circumferential strain (−14.42％±3.24％) and global longitudinal strain (−9.55％±2.79％) were found in the concentric LVH group. Strain rate analysis showed that eccentric LVH group had the lowest systolic global circumferential strain rate[(−0.84±0.25) s−1],diastolic global circumferential strain rate[(0.73±0.29) s−1],systolic global radial strain rate[(1.25±0.46) s−1]and diastolic global radial strain rate[(−1.18±0.50) s−1]. Concentric LVH group had the lowest systolic global longitudinal strain rate[(−0.62±0.16) s−1]and diastolic global longitudinal strain rate[(0.53±0.14) s−1]. There was no significant difference in native T1 values between concentric remodeling group and control group[1285.50 (85.25) ms vs. (1262.53±38.18) ms,P=0.083]. Eccentric LVH group had the largest native T1 value,which was significantly higher than that of control group[(1351.10±58.49) ms,vs. (1262.53±38.18) ms,P<0.001). Compared with control group,T2 values were significantly increased in all four patient subgroups (all P<0.05),and the T2 value[(54.86±8.71) ms]of eccentric LVH group was the largest. There was no significant difference in T2 values among different subgroups of CKD patients (all P>0.05). Native T1 value was independently correlated with hemoglobin content (adjusted R2=0.216,β=−0.442,P<0.001) and serum creatinine (adjusted R2=0.216,β=−0.220,P=0.010). Conclusions:CKD patients have decreased myocardial strain and increased native T1 and T2 values. The changes of myocardial tissue characterization are most obvious in patients with eccentric LVH.
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