摘要
目的利用心脏磁共振特征追踪(cardiovascular magnetic resonance-feature tracking,CMR-FT)成像获得心脏淀粉样变性(cardiac amyloidosis,CA)不同亚型患者的左心室整体及各区域层面的心肌应力值,探讨其在CA分型中的价值。材料与方法回顾性连续纳入有心内膜活检的CA患者,并根据免疫组化、血清免疫固定电泳和Tcm-DPD/HMDP/PYP闪烁成像,将患者分为20例免疫球蛋白轻链心脏淀粉样变性(immunoglobulin light chain cardiac amyloidosis,AL-CA)组和22例转甲状腺素蛋白心脏淀粉样变性(transthyretin cardiac amyloidosi,ATTR-CA)组。通过评估ATTR-CA组和AL-CA组患者延迟强化的类型和范围,反映组织特征学差异。通过CMR-FT技术得到左心室整体(2D和3D)以及各心肌层面[心外膜下(epicardial,epi)和心内膜下(endocardial,endo)]径向、周向和纵向应力,分析各参数的组间差异。用受试者工作特征曲线分析应力参数在鉴别两种CA类型中的准确性。结果与ATTR-CA组相比,AL-CA组的患者左心室射血分数略低,左心室舒张末期容积相对较小,但差异无统计学意义。校正体表面积后,ATTR-CA组的左室心肌质量略高于AL-CA组[左室心肌质量指数:(106.38±29.79)mL/m^(2)vs.(100.04±36.73)mL/m^(2)]。ATTR-CA型患者的延迟强化较多弥漫分布(60%),AL-CA型患者的左室心肌延迟强化多分布于endo。ATTR-CA组的3D左室心肌整体径向应力(12.96%±5.21%vs.16.58%±4.39%)、2D左室心肌整体纵向应力(-6.70%±1.94%vs.-7.87%±1.70%)、epi左室整体周向应力(global circumferential strain-epicardial,GCSepi)(-8.41%±2.78%vs.-10.51%±3.10%)及epi左室整体纵向应力(global longitudinal strain-epicardial,GLSepi)(-6.49%±2.03%vs.-8.15%±1.86%)的绝对值均低于AL-CA组(P值均<0.05)。GCSepi和GLSepi鉴别两种类型CA的准确性最高,AUC值均为0.705。logistic回归分析发现GLSepi是鉴别不同亚型的独立因素(OR=1.60,P=0.021)。结论CMR-FT成像在CA患者中可以提供有关心肌功能�
Objective:To obtain the myocardial strain values of the left ventricle at the global and regional level in patients with different subtypes of cardiac amyloidosis(CA)through cardiovascular magnetic resonance feature tracking(CMR-FT).Materials and Methods:This study included patients with CA who had undergone endocardial biopsy,and 20 cases of immunoglobulin light chain cardiac amyloidosis(AL-CA)and 22 cases of transthyretin cardiac amyloidosi(ATTR-CA)were retrospectively included according to immunohistochemistry,serum immunofixation electrophoresis,and Tcm/HMDP/PYP scintillation imaging.The type and range of late gadolinium enhancement in the two groups were evaluated to reflect the differences in histological characteristics.The radial,circumferential and longitudinal strains(2D and 3D)of the whole left ventricle and myocardium layers(subepicardial and subendocardial)were obtained by CMR-FT technique,and the differences of each parameter between groups were analyzed.Receiver operator characteristic curve analysis was used to analyze the accuracy of strain parameters in distinguishing the two CA types.Results:Compared with the ATTR-CA group,the left ventricular ejection fraction was slightly lower in the AL-CA group,and the left ventricular end-diastolic volume was relatively smaller,but didn't reach statistically significant.After body surface area correction,left ventricular mass in ATTR-CA group was slightly higher than that in AL-CA group[left ventricular mass index:(106.38±29.79)mL/m^(2) vs.(100.04±36.73)mL/m^(2)].The distribution of late gadolinium enhancement was more diffuse in patients with ATTR-CA type(60%)and more subendocardial in patients with AL-CA type.The absolute values of left ventricular global radial strain(3D)(12.96%±5.21%vs.16.58%±4.39%),global longitudinal strain(2D)(-6.70%±1.94%vs.-7.87%±1.70%),global circumferential strain-epicardial(GCSepi)(-8.41%±2.78%vs.-10.51%±3.10%)and global longitudinal strain-epicardial(GLSepi)(-6.49%±2.03%vs.-8.15%±1.86%)in ATTR-CA group were lower tha
作者
庄白燕
李爽
王辉
张宏凯
徐磊
ZHUANG Baiyan;LI Shuang;WANG Hui;ZHANG Hongkai;XU Lei(Department of Radiology,Beijing Anzhen Hospital/Beijing Institute of Heart,Lung and Blood Vessel Diseases/Department of Medical Imaging,Capital Medical University,Beijing 100029,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2024年第2期23-29,62,共8页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金项目(编号:U1908211、82271986)
首都医科大学临床专科学院(系)培养基金开放课题(编号:CCMU2023ZKYXY014)。
