Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong, Sichuan, 637000, China.
Sci Rep. 2017 Jun 19;7(1):3794. doi: 10.1038/s41598-017-03699-5.
Clinically, assessment of myocardial function is essential in patients with amyloid light-chain cardiac amyloidosis (AL-CA) to predict outcome and determine therapeutic approach. The aim of this study was to investigate the feasibility of cardiovascular magnetic resonance (CMR)-derived feature tracking algorithm for assessing left ventricular (LV) myocardial deformation in AL-CA, and to determine if these abnormal myocardial deformation parameters are correlated to impaired LV myocardial microvascular dysfunction. A total of 42 AL-CA patients, including 26 with preserved systolic function and 16 with impaired LVEF, and 35 healthy controls were enrolled and underwent CMR examination. Our result indicated that AL-CA patients had significantly reduced global peak strain (PS) (longitudinal, circumferential, and radial) (all P < 0.05). AL-CA patients with normal LVEF showed preserved longitudinal PS at apical and significantly reduced longitudinal PS at mid and basal segments. By Spearman's rank correlation analysis, the LV regional radial, circumferential, and longitudinal myocardial deformation values were correlated to myocardial upslope and MaxSI in CA, regardless of LVEF. This study indicated that the abnormal LV myocardial deformation of AL-CA patients can be monitored using feature tracking CMR, even in those with preserved LVEF; and the myocardial deformation was associated with coronary microvascular dysfunction.
临床上，评估心肌功能对于淀粉样轻链型心脏淀粉样变性（AL-CA）患者至关重要，有助于预测预后并确定治疗方法。本研究旨在探讨心血管磁共振（CMR）衍生的特征追踪算法评估 AL-CA 患者左心室（LV）心肌变形的可行性，并确定这些异常心肌变形参数是否与 LV 心肌微血管功能障碍有关。共纳入 42 例 AL-CA 患者，包括 26 例收缩功能正常和 16 例 LVEF 受损患者，以及 35 例健康对照者，所有患者均接受 CMR 检查。结果表明，AL-CA 患者的整体峰值应变（PS）（纵向、周向和径向）明显降低（均 P<0.05）。LVEF 正常的 AL-CA 患者心尖段纵向 PS 正常，中段和基底段纵向 PS 显著降低。Spearman 秩相关分析显示，LV 局部径向、周向和纵向心肌变形值与 CA 中的心肌斜率和最大信号强度相关，无论 LVEF 如何。本研究表明，特征追踪 CMR 可监测 AL-CA 患者的异常 LV 心肌变形，即使在 LVEF 正常的患者中也是如此；心肌变形与冠状动脉微血管功能障碍有关。
