Direct comparison of echocardiography speckle tracking and cardiac magnetic resonance feature tracking for quantification of right ventricular strain: a prospective intermodality study in functional mitral regurgitation.
Direct comparison of echocardiography speckle tracking and cardiac magnetic resonance feature tracking for quantification of right ventricular strain: a prospective intermodality study in functional mitral regurgitation.
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DOI：
10.1186/s44156-022-00011-8
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发表时间：
2022-11-01
影响因子：
6.3
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中科院分区：
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功能性二尖瓣返流（FMR）是右心室功能障碍（RVDYS）的已知风险因素。RV整体纵向应变（GLS）是RV功能的一个新兴指标;然而，超声心动图（回波）和心脏磁共振（CMR）的RV GLS之间的一致性程度以及每种模式在RVDYS诊断和全因死亡率和心力衰竭住院率统计方面的相对效用仍然未知。CMR显示32%的患者有RVDYS（EF <50%），其中NYHA分级较前级，左、右心室射血分数较前级低（均P <0.05）。RVDYS患者的RV GLS受损，无论是通过STE或FT-CMR定量，模式之间具有强相关性（r = 0.81）。STE和FT-CMR衍生的GLS均能很好地检测RVDYS（两者的AUC均为0.94），两种模式的游离壁应变性能相似（FT-CMR AUC 0.94，STE AUC 0.92），STE衍生的间隔应变（STE AUC 0.78和FT-CMR AUC 0.92）证明准确性较低。RV S '和TAPSE显示较低的诊断准确性（RV S' AUC 0.77和TAPSE AUC 0.81）。在中位随访51个月（IQR 42，60个月）期间，25%（n = 25）发生全因死亡或HF住院。STE和FT-CMR均推导出RV GLS的不良预后分层风险（STE p = 0.007，FT-CMR p = 0.005），而传统RV指数TAPSE和RV S '则没有推导出（TAPSE p = 0.30，S' p = 0.69）。RV GLS是RVDYS的一个可靠标志物，无论采用何种方式，它提供了增量诊断价值，并改善了传统RV指数以外的无事件生存期的风险分层。
Functional mitral regurgitation (FMR) is a known risk factor for right ventricular dysfunction (RVDYS). RV global longitudinal strain (GLS) is an emerging index of RV function; however, the magnitude of agreement between RV GLS by echocardiography (echo) and cardiac magnetic resonance (CMR) and the relative utility of each modality for both the diagnosis of RVDYS and prognostication of all-cause mortality and heart failure hospitalization remain unknown. 32% of patients had RVDYS (EF < 50%) on CMR, among whom there was more advanced NYHA class and lower LV and RV ejection fraction (all p < 0.05). RV GLS was impaired in patients with RVDYS whether quantified via STE or FT-CMR, with strong correlation between modalities (r = 0.81). Both STE and FT-CMR derived GLS yielded excellent detection of RVDYS (AUC 0.94 for both), paralleling similar performance for free wall strain by both modalities (FT-CMR AUC 0.94, STE AUC 0.92) with lower accuracy demonstrated by STE derived septal strain (STE AUC 0.78 and FT-CMR AUC 0.92). RV S’ and TAPSE showed lower diagnostic accuracy (RV S’ AUC 0.77 and TAPSE AUC 0.81). During median follow up of 51 months (IQR 42, 60 months), all-cause mortality or HF hospitalization occurred in 25% (n = 25). Both STE and FT-CMR derived RV GLS stratified risk for adverse prognosis (STE p = 0.007, FT-CMR p = 0.005) whereas conventional RV indices, TAPSE and RV S’, did not (TAPSE p = 0.30, S’ p = 0.69). RV GLS is a robust marker of RVDYS irrespective of modality which provides incremental diagnostic value and improves risk stratification for event free survival beyond conventional RV indices.