摘要
目的:应用特征追踪心脏MRI(FT-cMRI)对非梗阻性肥厚型心肌病(NOHCM)患者进行左房应变分析来评估左心房功能,并探究NOHCM对左心结构和功能的影响.方法:回顾性分析2020年1月-2022年12月本院58例非梗阻性肥厚型心肌病患者(NOHCM组)和30例健康对照者(HC组)的临床和MRI资料.MRI扫描序列主要为单次激发FSE亮血序列,扫描平面包括两腔、四腔和短轴位.应用CVI42软件测量左房容积指数(LAVI)和左房整体功能参数,后者包括心肌储备功能参数[总应变(εs)、峰值正向应变率(SRs)、左房总射血分数(LATEF)]、导管功能参数[主动应变(εe)、峰值早期负向应变率(SRe)、左房被动射血分数(LAPEF)]和升压泵功能参数[被动应变(εa)、峰值晚期负向应变率(SRa)、左房主动射血分数(LAAEF)],以及左室的功能[左室射血分数(LVEF)、左室心输出量(LVCO)和左室心脏指数(LVCI)]和大小参数[左室最大室壁厚度(LVWTmax)、左室心肌质量(LVM)、左室质量指数(LVMI)、左室舒张末期容积指数(LVEDVi)和左室收缩末期容积指数(LVESVi)].采用两样本t检验、Mann-Whitney U检验等统计学方法比较两组间各项定量参数值的差异,并采用Pearson或Spearman相关系数分析左房功能参数与左室的结构和功能参数之间的相关性.结果:NO-HCM组的LVWTmax、LVM、LVMI和LAVI值均显著高于HC组(P＜0.05),NOHCM组的左房功能参数值(LATEF、LAPEF、LAAEF、εs、εe、εa,SRs、SRe 和 SRa)均显著低于 HC 组(P＜0.05).NO-HCM 组左室心肌不同肥厚部位的LVWTmax的差异有统计学意义(P＜0.05),两组之间其它的左房、左室结构和功能参数值的差异无统计学意义(P＞0.05).左房大小正常的NOHCM患者的LATEF、LA-PEF、εs、εe、SRs和SRe值均显著低于HC组(P＜0.05),而LAAEF、εa和SRa值在两组之间的差异无统计学意义(P＞0.05).所有受试者的LATEF与εs、LAPEF与εe、LAAEF与εa之间均具有显著相关性(r＞0.70).结论:与健康对照组相比,NOHCM患者各时相左房功能均下降.在左房增大之前,左房的心肌储备和导管功能下降,而升压泵功能正常.各时相左房功能受损与左室的肥厚部位无显著相关性.各时相左房的LAEF与各项应变参数之间具有较强的相关性.
Abstract
Objective:To explore value of the feature tracking cardiac magnetic resonance ima-ging(FT-cMRI)in assessing left atrial function by performing left atrial strain analysis in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)and to investigate the effects of NO-HCM on left atrial and left ventricular structure and function.Methods:The clinical and MRI data of 58 patients with non-obstructive hypertrophic cardiomyopathy(NOHCM group)and 30 healthy controls(HC group)from January 2020 to December 2022 in our hospital were retrospectively analyzed.The main sequence for cMRI examination was bright blood technique with single shot fast spin-echo.The scanning planes were two-chamber,four-chamber,and short-axis positions.CVI42 software was used to measure left atrium volume index(LAVI),overall cardiac functional parameters including the re-servoir function[total strain(εs),peak positive strain rate(SRs),left atrial total ejection fraction(LATEF)],conduit function[passive strain(εe),peak early negative strain rate(SRe),left atrial pas-sive ejection fraction(LAPEF)],and booster pump function[active strain(εa),peak late negative strain rate(SRa),left atrial active ejection fraction(LAAEF)],and left ventricular function parame-ters[left ventricular ejection fraction(LVEF),left ventricular cardiac output(LVCO),left ventricular cardiac index(LVCI)]and left ventricular size parameters[(left ventricular maximum wall thickness(LVWTmax),left ventricular mass(LVM),left ventricular mass index(LVMI),left ventricular end-diastolic volume index(LVEDVi),left ventricular end-systolic volume index(LVESVi)].Statistical methods such as paired-sample t-test and Mann-Whitney U-test were used to compare the differences in the values of each quantitative parameter between the two groups.Pearson or Spearman correlation coefficient was used to analyze the correlation between the values of the left atrial functional parame-ters and the values of the structural and functional parameters of the left ventricle.Results:The values of LVWTmax,LVM,LVMI and LAVI in the NOHCM group were significantly higher than those in the HC group(all P＜0.05).All values of left atrial functional parameters(LATEF,LAPEF,LAAEF,εs,εe,εa,SRs,SRe,SRa)in the NOHCM group were significantly lower than those in the NC group(all P＜0.05).The difference in LVWTmax at different hypertrophic sites in the NOHCM group was statis-tically significant(P＜0.05),and the differences in the values of other left atrial and left ventricular structural and functional parameters between the two groups were not statistically significant(all P＞0.05).The values of LATEF,LAPEF,εs,εe,SRs,and SRe in NOHCM patients with normal left atrial size were significantly lower than those in the HC group(all P＜0.05),while there was no statistically significant difference in the values of LAAEF,εa and SRa between the two groups(all P＞0.05).Cor-relation between LATEF and εs,LAPEF and εe,and LAAEF and εa were strong(all r＞0.70).Conclu-sion:Compared with healthy controls,patients with NOHCM have decreased left atrial function in all temporal phases.Prior to left atrial enlargement,patients with NOHCM have decreased left atrial re-servoir and conduit function and normal booster pump function.Impaired left atrial function in all tem-poral phases is independent of the site of left ventricular hypertrophy.LAEF in all temporal phases of the left atrium is correlated strongly with strain parameters.
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