一项多中心验证研究中全球和区域二维斑点追踪应变与心脏磁共振标记的头对头比较
Head-to-Head Comparison of Global and Regional Two-Dimensional Speckle Tracking Strain Versus Cardiac Magnetic Resonance Tagging in a Multicenter Validation Study.
作者信息
Amzulescu Mihaela Silvia, Langet Hélène, Saloux Eric, Manrique Alain, Boileau Laurianne, Slimani Alisson, Allain Pascal, Roy Clotilde, de Meester Christophe, Pasquet Agnès, De Craene Mathieu, Vancraeynest David, Pouleur Anne-Catherine, Vanoverschelde Jean-Louis J, Gerber Bernhard L
机构信息
From the Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Service de Cardiologie, Université Catholique de Louvain, Brussels, Belgium (M.S.A., L.B., A.S., C.R., C.d.M., A.P., D.V., A.-C.P., J.-L.J.V., B.L.G.); Philips Clinical Research Board, Paris, France (H.L.); University Hospital of Caen, France (E.S.); EA 4650, Caen University, FHU REMOD-VHF, France (A.M.); and Philips Research, Medical Imaging (Medisys), Suresnes, France (P.A., M.D.C.).
出版信息
Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.117.006530.
BACKGROUND
Despite widespread use to characterize and refine prognosis, validation data of two-dimensional (2D) speckle tracking (2DST) echocardiography myocardial strain measurement remain scarce.
METHODS AND RESULTS
Global and regional subendocardial peak-systolic Lagrangian longitudinal (LS) and circumferential strain (CS) by 2DST and 2D-tagged (2DTagg) cardiac magnetic resonance imaging were compared against sonomicrometry in a dynamic heart phantom and among each other in 136 patients included prospectively at 2 centers. The ability of regional LS and CS 2DST and 2DTagg to identify late gadolinium enhancement was compared using receiver operating characteristics curves. In vitro, both LS-2DST and 2DTagg highly agreed with sonomicrometry (intraclass correlation coefficient [ICC], 0.89 and ICC, 0.90, both <0.001 with -3±2.8% and 0.34±4.35% bias, respectively). In patients, both global LS and global CS 2DST agreed well with 2DTagg (ICC, 0.89 and ICC, 0.80; <0.001); however, they provided systematically greater values (relative bias of -37±27% and -25±37% for global LS and global CS, respectively). On regional basis, however, ICC (from 0.17 to 0.81) and relative bias (from -9 to -98%) between 2DST and 2DTagg varied strongly among segments. Ability to discriminate infarcted versus noninfarcted segments by late gadolinium enhancement was similarly good for regional LS 2DTagg and 2DST (area under the curve, 0.66 versus 0.59; =0.08), while it was lower for CS 2DST than 2DTagg (area under the curve, 0.61 versus 0.75; <0.001).
CONCLUSIONS
The high accuracy against sonomicrometry and good agreement of global LS and global CS by 2DST and 2DTagg confirm the overall validity of 2DST strain measurement. Yet, higher intertechnique segmental variability and lower ability for detecting infarct suggest that 2DST strain estimates may be less performant on regional than on global basis.
背景
尽管二维（2D）斑点追踪（2DST）超声心动图心肌应变测量在表征和优化预后方面得到广泛应用，但其验证数据仍然匮乏。
方法与结果
在动态心脏模型中，将2DST和二维标记（2DTagg）心脏磁共振成像测得的整体和区域心内膜下收缩期峰值拉格朗日纵向（LS）和圆周应变（CS）与声测法进行比较，并在两个中心前瞻性纳入的136例患者中相互比较。使用受试者工作特征曲线比较区域LS和CS的2DST及2DTagg识别延迟钆增强的能力。在体外，LS-2DST和2DTagg与声测法高度一致（组内相关系数[ICC]分别为0.89和0.90，均<0.001，偏差分别为-3±2.8%和0.34±4.35%）。在患者中，整体LS和整体CS的2DST与2DTagg一致性良好（ICC分别为0.89和0.80；<0.001）；然而，它们系统性地给出了更大的值（整体LS和整体CS的相对偏差分别为-37±27%和-25±37%）。然而，在区域基础上，2DST和2DTagg之间的ICC（从0.17至0.81）和相对偏差（从-9至-98%）在各节段间差异很大。通过延迟钆增强区分梗死节段与非梗死节段的能力，区域LS的2DTagg和2DST同样良好（曲线下面积分别为0.66对0.59；P=0.08），而CS的2DST低于2DTagg（曲线下面积分别为0.61对0.75；<0.001）。
结论
2DST和2DTagg相对于声测法的高精度以及整体LS和整体CS的良好一致性证实了2DST应变测量的整体有效性。然而，更高的技术间节段变异性和更低的梗死检测能力表明，2DST应变估计在区域基础上可能不如在整体基础上表现出色。
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