Heart failure with preserved ejection fraction in post myocardial infarction patients: a myocardial magnetic resonance (MR) tissue tracking study.
Heart failure with preserved ejection fraction in post myocardial infarction patients: a myocardial magnetic resonance (MR) tissue tracking study.
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DOI：
10.21037/qims-22-793
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发表时间：
2023-03-01
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
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作者：
本研究旨在探讨心脏磁共振组织追踪（CMR-TT）技术在评价慢性心肌梗死（CMI）患者射血分数保留性心力衰竭（HFpEF）中的价值。在2016年6月至2022年3月期间，我们在这项回顾性研究中纳入了92例CMI患者和40例健康对照的连续系列。根据心力衰竭协会（HFA）-PEFF（步骤1：P，试验前评估;步骤2：E，超声心动图和利钠肽评分;步骤3：F1，功能测试;步骤4：F2，最终病因）诊断算法，将入组的CMI患者分为不同的亚组[HFpEF-CMI组（n=54）和非心力衰竭（HF）-CMI组（n=38）]。CMR扫描在中国医科大学第一医院进行。定量测量心肌损伤，如心肌应变参数的CMR-TT和梗死面积和透壁性晚期钆增强（LGE）派生的两个心室，进行了评估。采用单因素方差分析、独立样本t检验、秩和检验比较各组间心肌损害程度。Pearson或斯皮尔曼相关系数用于测量左心室（LV）应变与临床和功能参数之间的相关性。采用Logistic回归分析和受试者工作特征（ROC）曲线，筛选诊断HFpEF-CMI的最佳参数。与非HF-CMI患者和健康对照相比，HFpEF-CMI患者在所有三个方向（径向、周向和纵向）上均表现出显著受损的LV应变和应变率（所有P<0.001），而HFpEF-CMI患者与对照相比，右心室应变参数仅整体纵向应变（GLS）显著受损（P<0.001）。左室应变与N末端脑钠肽前体中度相关（径向、周向和纵向应变，分别为R=-0.401，R=0.408，R=0.407，P均<0.001）。三个方向的LV应变（径向、周向和纵向）[ROC曲线下面积（AUC）=0.707，95%置信区间（CI）：0.603-0.797; AUC =0.708，95% CI：0.604-0.798; AUC =0.731，95% CI：0.628-0.818; P<0.01]是HFpEF-CMI和非HF-CMI的判别因子。校正体重指数、年龄和性别后，多因素Logistic回归分析显示，左室应变和心肌梗死体积为独立因素（均P<0.05）。CMR-TT为临床医生提供了有用的额外成像参数，以便于评估伴有HFpEF的CMI患者。左室应变参数可以检测HFpEF-CMI患者的早期心功能不全，并对鉴别CMI后HFpEF和非HF患者具有潜在价值。
This study aimed to explore the value of cardiac magnetic resonance tissue tracking (CMR-TT) technology in evaluating heart failure with preserved ejection fraction (HFpEF) in patients with chronic myocardial infarction (CMI). Between June 2016 and March 2022, we included a consecutive series of 92 patients with CMI and 40 healthy controls in this retrospective study. The CMI patients enrolled were divided into different subgroups [HFpEF-CMI group (n=54) and non- heart failure (HF)-CMI group (n=38)] according to the Heart Failure Association (HFA)-PEFF (step 1: P, pre-test assessment; step 2: E, echocardiography and natriuretic peptide score; step 3: F1, functional testing; step 4: F2, final aetiology) diagnostic algorithm. CMR scan was performed at the First Hospital of China Medical University. Quantitative measurements of myocardial damage, such as myocardial strain parameters of both ventricles derived by CMR-TT and infarct size and transmurality by late gadolinium enhancement (LGE), were assessed. One-way analysis of variance, independent samples t-test, and rank sum test were used to compare myocardial impairment among groups. Pearson or Spearman correlation coefficient was used to measure correlations between left ventricular (LV) strains and clinical and functional parameters. Logistic regression analysis and receiver operating characteristic (ROC) curve were performed to identify the best parameter for diagnosing HFpEF-CMI. HFpEF-CMI patients demonstrated significantly impaired LV strains and strain rates in all of the three directions (radial, circumferential and longitudinal) compared to non-HF-CMI patients and healthy controls (P<0.001 for all), whereas only global longitudinal strain (GLS) was significantly impaired in HFpEF-CMI patients vs. controls for right ventricular strain parameters (P<0.001). LV strains showed moderate correlation with N-terminal pro-brain natriuretic peptide (radial, circumferential and longitudinal strain, R=−0.401, R=0.408, R=0.407, respectively, P<0.001 for all). LV strains in the three directions (radial, circumferential and longitudinal) [area under ROC curve (AUC) =0.707, 95% confidence interval (CI): 0.603–0.797; AUC =0.708, 95% CI: 0.604–0.798; AUC =0.731, 95% CI: 0.628–0.818; respectively, P<0.01 for all] were discriminators for HFpEF-CMI and non-HF-CMI. LV strains and myocardial infarction volume were independent factors in multi-logistic regression analysis after adjusting for body mass index, age, and sex (P<0.05 for all). CMR-TT provides clinicians with useful additional imaging parameters to facilitate the assessment of CMI patients with HFpEF. LV strain parameters can detect early cardiac insufficiency in patients with HFpEF-CMI and have potential value for discriminating between HFpEF and non-HF patients post-CMI.
影响因子：
6
作者：
Pothineni NV;Kattoor AJ;Kovelamudi S;Kenchaiah S
通讯作者：
Kenchaiah S