Amaki Makoto, Savino John, Ain David L, Sanz Javier, Pedrizzetti Gianni, Kulkarni Hemant, Narula Jagat, Sengupta Partho P
From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.).
Circ Cardiovasc Imaging. 2014 Sep;7(5):819-27. doi: 10.1161/CIRCIMAGING.114.002103. Epub 2014 Aug 8.
Variations in longitudinal deformation of the left ventricle have been suggested to be useful for differentiating chronic constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). We assessed left ventricular mechanics derived from cardiac magnetic resonance (CMR) cine-based and 2-dimensional echocardiography-based tissue tracking to determine intermodality consistency of diagnostic information for differentiating CP from RCM.
We retrospectively identified 92 patients who underwent both CMR and 2-dimensional echocardiography and who had a final diagnosis of CP (n=28), RCM (n=30), or no structural heart disease (n=34). Global longitudinal strain from long-axis views and circumferential strain from short-axis views were measured on 2-dimensional echocardiographic and CMR cine images using the same offline software. Logistic regression models with receiver operating characteristics curves, continuous net reclassification improvement, and the integrated discrimination improvement (IDI) were used for assessing the incremental predictive performance. Global longitudinal strain was higher in patients with CP than in those with RCM (P<0.001), and both techniques were found to have similar diagnostic value (area under the curve, 0.84 versus 0.88 for CMR and echocardiography, respectively). For echocardiography, the addition of global longitudinal strain to respiratory septal shift and early diastolic mitral annular velocity resulted in improved continuous net reclassification improvement (P<0.001 for both) and integrated discrimination improvement (P=0.005 and 0.024) for both models. Similarly, for CMR, the addition of global longitudinal strain to septal shift and pericardial thickness resulted in improved continuous net reclassification improvement (P<0.001 for both) and integrated discrimination improvement (P=0.003 and <0.001).
CMR and echocardiography tissue tracking-derived left ventricular mechanics provide comparable diagnostic information for differentiating CP from RCM.
左心室纵向变形的变化被认为有助于鉴别慢性缩窄性心包炎（CP）和限制型心肌病（RCM）。我们评估了源自心脏磁共振（CMR）电影成像和基于二维超声心动图的组织追踪的左心室力学，以确定鉴别CP与RCM的诊断信息的模态间一致性。
我们回顾性纳入了92例接受CMR和二维超声心动图检查且最终诊断为CP（n = 28）、RCM（n = 30）或无结构性心脏病（n = 34）的患者。使用相同的离线软件在二维超声心动图和CMR电影图像上测量长轴视图的整体纵向应变和短轴视图的圆周应变。采用具有受试者操作特征曲线、连续净重新分类改善和综合鉴别改善（IDI）的逻辑回归模型来评估增量预测性能。CP患者的整体纵向应变高于RCM患者（P < 0.001），并且发现两种技术具有相似的诊断价值（曲线下面积，CMR和超声心动图分别为0.84和0.88）。对于超声心动图，将整体纵向应变添加到呼吸性室间隔移位和舒张早期二尖瓣环速度中，导致两个模型的连续净重新分类改善（两者均P < 0.001）和综合鉴别改善（P = 0.005和0.024）。同样，对于CMR，将整体纵向应变添加到室间隔移位和心包厚度中，导致连续净重新分类改善（两者均P < 0.001）和综合鉴别改善（P = 0.003和<0.001）。
CMR和超声心动图组织追踪得出的左心室力学为鉴别CP与RCM提供了可比的诊断信息。
