Incremental value of cardiovascular magnetic resonance feature tracking derived atrial and ventricular strain parameters in a comprehensive approach for the diagnosis of acute myocarditis
Incremental value of cardiovascular magnetic resonance feature tracking derived atrial and ventricular strain parameters in a comprehensive approach for the diagnosis of acute myocarditis
复制标题
DOI：
10.1016/j.ejrad.2018.05.012
复制
发表时间：
2018-07-01
影响因子：
3.3
通讯作者：
Baessler, Bettina
中科院分区：
文献类型：
--
作者：
Doerner, Jonas;Bunck, Alexander C.;Baessler, Bettina
目的/介绍：本研究旨在评价心脏磁共振(CMR)特征跟踪(FT)房室应变分析在急性心肌炎(心肌炎)患者中的增量诊断价值，作为建立Lake-Louise标准(LLC)的补充工具。材料和方法：86例经临床证实的心肌炎患者和30名健康对照组接受了全面的CMR检查。除已建立的LLC外，FT还评估了左(LA)和右心房(RA)以及左(LV)和右心室(RV)的应变参数。结果：心肌炎患者左房被动应变显著降低(左房收缩应变率：26.3+/-14.5vs.33.5+/-10.1%，p=0.007)，左房早期负应变率显著降低(左房收缩早期应变率：-1.94+/-0.591/S vs.-1.46+/-0.621/S，p<；.001)，LV整体纵向应变(LV GLS：-17.2+/-4.9%vs.-13.3+/-6.2%，p<；.001)，LV室中周向应变(LV Mid CS：-25.9+/-4.7%vs.-22.0+/-6.5%，p<；与健康对照组相比，右室基础周长SR增加(右室基础CSR：-0.70+/-028比-0.58+/-0.341/S，p=0.096)。在心肌炎和左心功能正常患者的亚组分析中，与健康对照组相比，右室基础CSR显著增加(-0.74+/-0.27比-0.57+/-0.261/S；p=0.035)，而左房SRE(-1.49+/-0.59比-1.32+/-0.74%；p=0.005)显著降低。多因素Logistic回归分析显示，LA SRE和RV基础CSR是左心功能保持不变的心肌炎的最佳独立预测因素。与LLC相结合，应变参数提高了对这类患者的诊断能力(曲线下面积(AUC)：LLC：0.78，LLC+LV GLS+LA SRE：0.86)，而LA SRE是最好的单项参数(AUC：0.72)。结论：将定量的CMR房室应变参数与已建立的LLC参数相结合，可以提高对可疑心肌炎患者的诊断性能，包括左心功能正常者。进一步的研究应集中在LA功能上，LA功能对早期功能变化似乎比LV功能更敏感。
Purpose/introduction: This study aims to evaluate the incremental diagnostic value of cardiac magnetic resonance (CMR) feature tracking (FT) derived atrial and ventricular strain-analysis in patients with acute myocarditis (myocarditis) as an additional tool to established Lake-Louise criteria (LLC).Material and methods: A total of 86 patients with clinically proven myocarditis and 30 healthy controls underwent a comprehensive CMR protocol. In addition to established LLC, FT derived strain parameters from the left (LA) and right atrium (RA) as well as the left (LV) and right ventricle (RV) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic performance.Results: Patients with myocarditis showed significantly reduced LA passive strain (LA epsilon(e): 26.3 +/- 14.5 vs. 33.5 +/- 10.1%, p = .007), LA peak early negative strain rate (LA SRe: -1.94 +/- 0.59 1/s vs. -1.46 +/- 0.62 1/s, p < .001), LV global longitudinal strain (LV GLS: -17.2 +/- 4.9% vs. -13.3 +/- 6.2%, p < .001), LV midventricular circumferential strain (LV mid CS: -25.9 +/- 4.7% vs. -22.0 +/- 6.5%, p < .001), and an increased RV basal circumferential SR (RV basal CSR: -0.70 +/- 028 vs. -0.58 +/- 0.34 1/s, p = .096) compared to healthy controls. In a subgroup analysis of patients with myocarditis and preserved LV function, RV basal CSR was also significantly increased compared to healthy controls ( - 0.74 +/- 0.27 vs. - 0.57 +/- 0.26 1/s; p = .035) whereas LA SRe ( -1.49 +/- 0.59 vs. -1.32 +/- 0.74%; p = .005) was significantly reduced. In multinominal logistic regression analysis, LA SRe and RV basal CSR proved to be the best independent predictors of myocarditis with preserved LV function. Combined with LLC, strain parameters enhanced the diagnostic performance in such patients (Areas under the curve (AUC): LLC: 0.78, LLC + LV GLS + LA SRe: 0.86), whereas LA SRe was the best performing single parameter (AUC: 0.72).Conclusion: Combining quantitative CMR derived atrial and ventricular strain parameters with established LLC parameters can improve the diagnostic performance in patients with suspected myocarditis, including those with preserved LV function. Further investigations should focus on LA function, which appears to be more sensitive to early functional changes than LV function.