MR cine DENSE dyssynchrony parameters for the evaluation of heart failure: comparison with myocardial tissue tagging.
MR cine DENSE dyssynchrony parameters for the evaluation of heart failure: comparison with myocardial tissue tagging.
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DOI：
10.1016/j.jcmg.2011.12.024
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发表时间：
2012-08
影响因子：
14
通讯作者：
Bilchick, Kenneth C.
中科院分区：
文献类型：
--
作者：
Budge, Loren P.;Helms, Adam S.;Salerno, Michael;Kramer, Christopher M.;Epstein, Frederick H.;Bilchick, Kenneth C.
我们试图评估基于应变区域异质性（周向（CURE）、纵向（LURE）和径向（RURE）均匀性比估计）的自动机械不同步（MD）参数相对于基于区域时间达到峰值收缩的参数的有效性，使用心脏磁共振（CMR）电影DENSE（受激回波位移编码）通过心肌组织标记（MTT）应变数据进行验证。基于区域应变的傅里叶变换 (FT) 的不同步测量，例如 CURE（之前在 CRT 候选者中进行评估），直接评估 MD 并产生简单的全局不同步指数；然而，相对于峰值应变时间 (SD12) 的 12 段标准偏差或峰值应变时间的最大区域延迟的性能未知。使用 CMR (1.5T 西门子 Avanto) 在 13 只犬中获得 Cine DENSE 和 MTT：3 只正常对照，5 只患有心动过速起搏诱发的心力衰竭 (HF) 和左束支消融 (LBBB-HF)，5 只患有 HF 和窄 QRS (NQRS-HF)。使用两种 CMR 方法确定应变和不同步参数。与正常病例相比，两个心力衰竭组的峰值应变和左心室射血分数（LVEF）均降低。基于组内相关系数 (ICC[95%CI])，cine DENSE 和 MTT 之间存在很强的一致性（CURE：0.99[0.96,1.00]；LURE：0.92[0.77,0.98]；ECC：0.95[0.72,0.99]；ELL：0.82[0.42，0.97]）。基于 FT 的指标（量表 0-1），特别是 CURE，在 LBBB-HF 和 NQRS-HF 组之间具有高度区分性（中位差[95%CI]；CURE：0.60[0.43,0.76]；LURE：0.39[0.19,0.58]；RURE：0.22[0.04,0.40]）。相反，达到峰值时间参数的组间差异的相对置信区间较宽，表明区分的一致性较差（中位差[95%CI]；SD12-ECC：52.5[-4.0,109.2]；SD12-ELL：40.9[-5.3,87.1]；SD12-ERR：42.0[0.4，83.6]）。基于 FT 的参数与达峰时间参数之间的相关性显着（CURE/SD12-ECC：r=-0.62，p=0.03；LURE/SD12-ELL：r=-0.76，p=0.005），但不如达峰时间参数之间的相关性那么紧密。基于 FT 的自动化周向、径向和纵向不同步测量与峰值时间参数相比具有优势。 Cine DENSE 对于该应用非常有效，并通过 MTT 进行了验证。有必要使用 CMR 或其他成像方式对 CRT 候选者进行进一步的临床评估。
We sought to assess the effectiveness of automated mechanical dyssynchrony (MD) parameters based on regional heterogeneity of strain (circumferential (CURE), longitudinal (LURE), and radial (RURE) uniformity ratio estimates) relative to parameters based on regional time to peak contraction using cardiac magnetic resonance (CMR) cine DENSE (Displacement Encoding with Stimulated Echoes) validated with myocardial tissue tagging (MTT) strain data. Dyssynchrony measures based on the Fourier transformation (FT) of regional strain, such as CURE (previously evaluated in CRT candidates), directly assess MD and yield straightforward global dyssynchrony indices; however, performance relative to the 12-segment standard deviation in time to peak strain (SD12) or maximal regional delay in time to peak strain is unknown. Cine DENSE and MTT were obtained using CMR (1.5T Siemens Avanto) in 13 canines: 3 normal controls, 5 with tachycardia pacing-induced heart failure (HF) and left bundle branch ablation (LBBB-HF), and 5 with HF and narrow QRS (NQRS-HF). Strain and dyssynchrony parameters were determined using both CMR methods. Both HF groups had reduced peak strains and left ventricular ejection fraction (LVEF) compared to normal cases. There was strong agreement between cine DENSE and MTT based on intraclass correlation coefficients (ICC[95%CI]) (CURE:0.99[0.96,1.00]; LURE:0.92[0.77,0.98]; ECC:0.95[0.72,0.99]; ELL:0.82[0.42, 0.97]). FT-based metrics (scale 0–1), in particular CURE, discriminated highly between LBBB-HF and NQRS-HF groups (median difference[95%CI]; CURE:0.60[0.43,0.76]; LURE:0.39[0.19,0.58]; RURE:0.22[0.04,0.40]). In contrast, relative confidence intervals for group differences in time-to-peak parameters were wide, indicating less consistent discrimination (median difference[95%CI]; SD12-ECC:52.5[-4.0,109.2]; SD12-ELL:40.9[-5.3,87.1]; SD12-ERR:42.0[0.4, 83.6]). Correlations between FT-based and time-to-peak parameters were significant (CURE/SD12-ECC:r=-0.62, p=0.03; LURE/SD12-ELL:r=-0.76, p=0.005), but not as tight as correlations between time-to-peak parameters. Automated FT-based circumferential, radial, and longitudinal dyssynchrony measures compare favorably with time-to-peak parameters. Cine DENSE was effective for this application and validated with MTT. Further clinical evaluation in CRT candidates using CMR or other imaging modalities is warranted.
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