多参数心脏磁共振在射血分数保留型心力衰竭患者中的临床诊断价值

Clinical value of multi-parameter cardiac magnetic resonance in patients with heart failure with preserved ejection fraction

摘要

目的 探讨多参数心脏磁共振(CMR)定量技术检查心力衰竭(HF)患者中,对左心室射血分数(LVEF)保留型心力衰竭(HFpEF)患者的诊断价值。方法 回顾性分析146例HF患者的CMR图像,其中包括HFpEF组61例,LVEF轻度降低型心衰组(HFmrEF)41例,LVEF降低型心衰组(HFrEF)44例,以及健康对照组47例。对比各组左心室功能指标[左心室舒张末期容积指数(LVEDVi)、收缩末期容积指数(LVESVi)、LVEF]、心肌应变参数[整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)]及CMR定量组织学参数[初始T1值(native T1)、增强后T1值(enhanced T1)、细胞外容积(ECV)]。采用受试者工作特征(ROC)曲线评估各参数对HFpEF与健康对照的鉴别效能。结果 HFmrEF组和HFrEF组的左室功能参数LVEDVi、LVESVi显著高于HFpEF组及健康对照组,LVEF显著低于其他组,差异具有统计学意义(P＜0.05),HFpEF组与健康对照组的左室功能参数差异无统计学意义(P＞0.05)。HFmrEF组和HFrEF组的心肌应变参数GLS、GCS、GRS显著低于HFpEF组及健康对照组,差异具有统计学意义(P＜0.05)；HFpEF组心肌应变参数明显低于健康对照组,差异具有统计学意义(P＜0.05)。CMR定量组织学参数中,健康对照组、HFpEF组、HFmrEF组、HFrEF组native T1值及ECV逐渐升高,且差异具有统计学意义(P＜0.05)。native T1、心肌应力和ECV三者联合的ROC曲线中,对区分HFpEF与健康对照组的曲线下面积、敏感度、特异度分别为0.94、85.25%、89.36%,优于应用单因素(P＜0.05)。结论 CMR多参数成像在HFpEF患者中表现为心室容积功能的保留、心肌应变的下降以及native T1与ECV值的升高。心肌应力、native T1和ECV联合评估可提高HFpEF的诊断效能。

Abstract

Objective To explore the value of multi-parameter quantitative technique of cardiac magnetic resonance (CMR) in the differential diagnosis of patients with heart failure (HF) who have preserved ejection fraction (HFpEF). Methods A retrospective analysis was conducted on the CMR images of 146 patients with HF, including 61 cases in HFpEF group, 41 cases in mildly reduced ejection fraction group (HFmrEF), 44 cases in reduced ejection fraction heart failure group (HFrEF), and 47 cases in healthy control group. We compared different groups in the left ventricular function indicators [left ventricular end-diastolic volume index (LVEDVi), end-systolic volume index (LVESVi), ejection fraction (LVEF)], myocardial strain parameters [global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS)], and quantitative histological parameters of cardiac magnetic resonance [native T1 value, enhanced T1 value and extracellular volume (ECV)]. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each parameter in differentiating HFpEF from healthy controls. Results The left ventricular functional parameters, LVEDVi and LVESVi in the HFmrEF group and the HFrEF group were significantly higher than those in the HFpEF group and the control group, while LVEF was significantly lower than that in the other groups, with statistically significant differences (P＜0.05). However, there was no statistically significant difference in left ventricular functional parameters between the HFpEF and the control group (P＞0.05). The myocardial strain parameters GLS, GCS and GRS in the HFmrEF group and the HFrEF group were significantly lower than those in the HFpEF group and the control group, with statistically significant differences (P＜0.05). The myocardial strain was significantly lower in the HFpEF group than in the control group, and the difference was statistically significant (P＜0.05). Among the quantitative histological parameters of cardiac magnetic resonance, the native T1 values and ECV in the normal group, HFpEF group, HFmrEF group, and HFrEF group gradually increased, and the differences were statistically significant (P＜0.05). The combined effect of native T1, myocardial stress, and ECV in differentiating the area under the curve (AUC), sensitivity and specificity of HFpEF from healthy people was 0.94, 85.25% and 89.36%, respectively. The combined AUC of the three was greater than that of any single factor (P＜0.05). Conclusion CMR multi-parameter imaging in HFpEF patients is manifested as the preservation of ventricular volume function, decrease in myocardial strain, and increase in native T1 and ECV values. The combination of myocardial stress, native T1 and ECV can improve the diagnostic efficacy of HFpEF.

关键词

心脏磁共振(CMR) / 心力衰竭 / 初始T1值 / 细胞外容积 / 心肌应变

Key words

cardiac magnetic resonance(CMR) / heart failure / native T1 / extracellular volume / myocardial strain

参考文献

[1] SNIPELISKY D, CHAUDHRY S P, STEWART G C. The many faces of heart failure[J]. Card Electrophysiol Clin, 2019, 11(1): 11-20.

[2] BEHNOUSH A H, KHALAJI A, NADERI N, et al. ACC/AHA/HFSA 2022 and ESC 2021 guidelines on heart failure comparison[J]. ESC Heart Fail, 2023, 10(3): 1531-1544.

[3] REDFIELD M M, BORLAUG B A. Heart failure with preserved ejection fraction: a review[J]. JAMA, 2023, 329(10): 827-838.

[4] DUNLAY S M, ROGER V L, REDFIELD M M. Epidemiology of heart failure with preserved ejection fraction[J]. Nat Rev Cardiol, 2017, 14(10): 591-602.

[5] ROMMEL K P, LÜCKE C, LURZ P. Diagnostic and prognostic value of CMR T1—mapping in patients with heart failure and preserved ejection fraction[J]. Rev Esp Cardiol(Engl Ed), 2017, 70(10): 848-855.

[6] OBOKATA M, REDDY Y N V, BORLAUG B A. Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods[J]. JACC Cardiovasc Imaging, 2020, 13(1 Pt 2): 245-257.

[7] DZHIOEVA O, BELYAVSKIY E. Diagnosis and management of patients with heart failure with preserved ejection fraction (HFpEF): current perspectives and recommendations[J]. Ther Clin Risk Manag, 2020, 16: 769-785.

[8] TAYLOR A J, SALERNO M, DHARMAKUMAR R, et al. T1 mapping: basic techniques and clinical applications[J]. JACC Cardiovasc Imaging, 2016, 9(1): 67-81.

[9] MOHAREM E S. T1 mapping in heart failure: prognostic implications[J]. Arq Bras Cardiol, 2021, 116(5): 926-927.

[10] MOUSTAFA A, KHAN M S, ALSAMMAN M A, et al. Prognostic significance of T1 mapping parameters in heart failure with preserved ejection fraction: a systematic review[J]. Heart Fail Rev, 2021, 26(6): 1325-1331.

[11] PAN J A, MICHAËLSSON E, SHAW P W, et al. Extracellular volume by cardiac magnetic resonance is associated with biomarkers of inflammation in hypertensive heart disease[J]. J Hypertens, 2019, 37(1): 65-72.

[12] SMISETH O A, RIDER O, CVIJIC M, et al. Myocardial strain imaging: theory, current practice, and the future[J]. JACC Cardiovasc Imaging, 2025, 18(3): 340-381.

[13] CERQUEIRA M D, WEISSMAN N J, DILSIZIAN V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association[J]. Circulation, 2002, 105(4): 539-542.

[14] KELLMAN P, WILSON J R, XUE H, et al. Extracellular volume fraction mapping in the myocardium, part 1: evaluation of an automated method[J]. J Cardiovasc Magn Reson, 2012, 14(1): 63.

[15] LIN K, SARNARI R, PATHROSE A, et al. Cine MRI characterizes HFpEF and HFrEF in post—capillary pulmonary hypertension[J]. Eur J Radiol, 2021, 139: 109679.

[16] ZHANG Y, ZHANG X, WANG Y, et al. Relationship between diffuse fibrosis assessed by CMR and depressed myocardial strain in different stages of heart failure[J]. Eur J Radiol, 2023, 164: 110848.

[17] WU C K, LEE J K, HSU J C, et al. Myocardial adipose deposition and the development of heart failure with preserved ejection fraction[J]. Eur J Heart Fail, 2020, 22(3): 445-454.

[18] MARON M S, WELLS S. Myocardial strain in hypertrophic cardiomyopathy: a force worth pursuing?[J]. JACC Cardiovasc Imaging, 2019, 12(10): 1943-1945.

[19] CAO J J, NGAI N, DUNCANSON L, et al. A comparison of both DENSE and feature tracking techniques with tagging for the cardiovascular magnetic resonance assessment of myocardial strain[J]. J Cardiovasc Magn Reson, 2018, 20(1): 26.

[20] KIM P K, HONG Y J, IM D J, et al. Myocardial T1 and T2 mapping: techniques and clinical applications[J]. Korean J Radiol, 2017, 18(1): 113-131.

[21] MOON J C, MESSROGHLI D R, KELLMAN P, et al. Myocardial T1 mapping and extracellular volume quantification: a society for cardiovascular magnetic resonance (SCMR) and CMR working group of the European Society of Cardiology Consensus Statement[J]. J Cardiovasc Magn Reson, 2013, 15(1): 92.

[22] BURT J R, ZIMMERMAN S L, KAMEL I R, et al. Myocardial T1 mapping: techniques and potential applications[J]. Radiographics, 34: 377-395.

[23] ROMMEL K P, VON ROEDER M, LATUSCYNSKI K, et al. Extracellular volume fraction for characterization of patients with heart failure and preserved ejection fraction[J]. J Am Coll Cardiol, 2016, 67(15): 1815-1825.

[24] GERMAIN P, EL GHANNUDI S, JEUNG M Y, et al. Native T1 mapping of the heart: a pictorial review[J]. Clin Med Insights: Cardiol, 2014, 8(S4): 1-11.

基金资助

陕西省重点研发计划项目-一般项目(2023-YBSF-068)

陕西省重点研发计划项目-高校联合项目(2020GXLH-Y-026)