El Ghannudi Soraya, Germain Philippe, Jeung Mi-Young, Breton Elodie, Croisille Pierre, Durand Emmanuel, Roy Catherine, Gangi Afshin
Department of Radiology, University Hospital, Strasbourg, France; Department of Nuclear Medicine, University Hospital, Strasbourg, France.
J Magn Reson Imaging. 2014 Nov;40(5):1238-46. doi: 10.1002/jmri.24447. Epub 2013 Nov 7.
To define which circumferential strain MR-tagging metrics of left intraventricular dyssynchrony better identifies patients with systolic dysfunction against control subjects.
One hundred fifty subjects were studied: (i) controls with ejection fraction (EF) > 55% (n = 84), (ii) patients with EF ≤ 55% not eligible for cardiac resynchronization therapy (CRT) (n = 52), and (iii) patients eligible for CRT according to the ESC guidelines (n = 14). Tagging cine MR-based circumferential filtered strain curves were extracted. Six dyssynchrony indices were studied: standard deviation (SD) of peak strain (SD_Ecc_ES), SD of time-to-peak (SD_TTP), strain delay index (LIM), regional variance vector (RVV), circumferential uniformity ratio estimate (CURE), and uniformity of strain TTP (US_TTP).
All metrics show significant differences between the three groups (ANOVA, P < 10(-4) ) and are correlated with EF. Significantly higher AUC values of ROC curves between patients with normal vs. decreased EF were obtained with SD_TTP (0.998) and CURE (0.995). Agreement among different methods was fair to good (kappa 0.32 to 0.89). Interobserver variability was best for CURE (1.2%) and US_TTP (0.8%) while more than 3-times larger for other metrics.
SD_TTP and CURE are the most discriminant dyssynchrony metrics for systolic dysfunction. However, taking into account the method's variability argues in favor of indices of uniformity of the strain, ie, CURE and US_TTP.
确定左心室内不同步的哪些圆周应变磁共振标记指标能更好地鉴别收缩功能障碍患者与对照受试者。
研究了150名受试者：（i）射血分数（EF）>55%的对照组（n = 84），（ii）EF≤55%且不符合心脏再同步治疗（CRT）条件的患者（n = 52），以及（iii）根据欧洲心脏病学会（ESC）指南符合CRT条件的患者（n = 14）。提取基于标记电影磁共振的圆周滤波应变曲线。研究了六个不同步指标：峰值应变标准差（SD_Ecc_ES）、达峰时间标准差（SD_TTP）、应变延迟指数（LIM）、区域方差向量（RVV）、圆周均匀度比估计值（CURE）和应变达峰时间均匀度（US_TTP）。
所有指标在三组之间均显示出显著差异（方差分析，P < 10⁻⁴），且与EF相关。SD_TTP（0.998）和CURE（0.995）在EF正常与降低的患者之间获得了显著更高的ROC曲线AUC值。不同方法之间的一致性为中等至良好（kappa值为0.32至0.89）。观察者间变异性对于CURE（1.2%）和US_TTP（0.8%）最佳，而其他指标则超过其3倍以上。
SD_TTP和CURE是收缩功能障碍最具鉴别力的不同步指标。然而，考虑到方法的变异性，支持应变均匀性指标，即CURE和US_TTP。
