高血压性心脏病伴左心室心肌肥厚和不伴左心室心肌肥厚患者的氧敏感性心血管磁共振：力学改变和心脏 BOLD 成像的新视角。

Oxygenation-sensitive cardiovascular magnetic resonance in hypertensive heart disease with left ventricular myocardial hypertrophy and non-left ventricular myocardial hypertrophy: Insight from altered mechanics and cardiac BOLD imaging.

机构信息

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Department of Radiology, Wayne State University, Detroit, Michigan, USA.

出版信息

J Magn Reson Imaging. 2018 Nov;48(5):1297-1306. doi: 10.1002/jmri.26055. Epub 2018 May 7.

DOI:10.1002/jmri.26055

PMID:29734491

Abstract

BACKGROUND

BOLD (blood oxygen level dependent) MRI can detect regional condition of myocardial oxygen supply and demand by means of paramagnetic properties.

PURPOSE

Noninvasive assessment of myocardial oxygenation by BOLD MRI in hypertensive patients with hypertension (HTN) left ventricular myocardial hypertrophy (LVMH) and HTN non-LVMH and its correlation with myocardial mechanics were performed.

STUDY TYPE

Prospective.

POPULATION

Twenty patients with HTN LVMH, 21 patients with HTN non-LVMH, and 23 normotensive controls were enrolled.

FIELD STRENGTH/SEQUENCE: Cine imaging, T2* and T1 mapping sequences were achieved at 3.0T.

ASSESSMENT

Dedicated T1 mapping, T2*, and cine imaging analysis were performed by two radiologists using cvi42.

STATISTICAL TESTS

One-way analysis of variance, Kruskal-Wallis test, Bland-Altman analysis, Pearson's correlation coefficient, Spearman's rank correlation.

RESULTS

T2* values of HTN LVMH group were significantly lower versus the controls (23.78 ± 3.09 versus 30.77 ± 2.71; P < 0.001) and HTN non-LVMH group (23.78 ± 3.09 versus 28.64 ± 4.23; P < 0.001). Left ventricular peak circumferential strain were reduced in HTN LVMH patients compared with other two groups (-11.32 [-15.64, -10.3], -16.78 [-19.35, -15.34], and -19.73 [-20.57, -18.73]; P < 0.05); and longitudinal strain of HTN LVMH patients were lower than other two groups (-11.31 ± 2.91, -15.1 ± 3.06, and -18.85 ± 1.85; P < 0.05); radial strain of HTN LVMH patients were also lower than other two groups (25.03 ± 16, 40.95 ± 17.5 and 47.9 ± 10.23; P < 0.05). Extracellular volume correlated with peak circumferential, longitudinal, and radial strain (spearman rho = 0.6, 0.64, and -0.69; P < 0.05), respectively; T2* negatively correlated with peak circumferential and longitudinal strain (spearman rho = -0.43 and -0.49; P < 0.05), respectively. Patients with lower T2* values had significant decreases in myocardial mechanics (P < 0.05).

DATA CONCLUSION

HTN LVMH patients have both impaired myocardial mechanics and decreased T2* values compared with HTN non-LVMH and normotensive groups. BOLD MRI could provide a feasible assessment modality for detecting altered T2* due to the change of de-oxygenated hemoglobin and hence to the change of signal intensity in oxygenation-sensitive images.

LEVEL OF EVIDENCE

1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1297-1306.

摘要

背景

BOLD（血氧水平依赖）MRI 可以通过顺磁性特性来检测心肌氧供需的区域状态。

目的

通过 BOLD MRI 对高血压伴左心室心肌肥厚（LVH）和高血压非 LVH 以及与心肌力学相关的高血压患者进行心肌氧合的无创评估。

研究类型

前瞻性。

人群

20 例高血压伴 LVH 患者、21 例高血压非 LVH 患者和 23 例血压正常的对照者被纳入。

场强/序列：在 3.0T 上获得电影成像、T2* 和 T1 映射序列。

评估

两位放射科医生使用 cvi42 进行专用 T1 映射、T2* 和电影成像分析。

统计学检验

单因素方差分析、Kruskal-Wallis 检验、Bland-Altman 分析、Pearson 相关系数、Spearman 秩相关。

结果

与对照组（23.78±3.09 比 30.77±2.71；P<0.001）和高血压非 LVH 组（23.78±3.09 比 28.64±4.23；P<0.001）相比，高血压伴 LVH 患者的 T2值明显更低。与其他两组相比，高血压伴 LVH 患者的左心室峰值周向应变降低（-11.32[-15.64，-10.3]、-16.78[-19.35，-15.34]和-19.73[-20.57，-18.73]；P<0.05）；高血压伴 LVH 患者的纵向应变也低于其他两组（-11.31±2.91、-15.1±3.06 和-18.85±1.85；P<0.05）；高血压伴 LVH 患者的径向应变也低于其他两组（25.03±16、40.95±17.5 和 47.9±10.23；P<0.05）。细胞外容积与峰值周向、纵向和径向应变呈正相关（Spearman rho=0.6、0.64 和-0.69；P<0.05）；T2与峰值周向和纵向应变呈负相关（Spearman rho=-0.43 和-0.49；P<0.05）。T2*值较低的患者心肌力学明显下降（P<0.05）。