验证一种快速半自动方法，用于评估电影心血管磁共振成像上的左心房纵向相位应变。
Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging.
机构信息
National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
出版信息
J Cardiovasc Magn Reson. 2018 Nov 5;20(1):71. doi: 10.1186/s12968-018-0496-1.
BACKGROUND
Abnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain.
METHODS
We studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain ε and strain rate SR), conduit function (conduit strain ε and strain rate SR) and booster pump function (booster strain ε and strain rate SR).
RESULTS
There was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for ε, 18.1 ± 4.3% for ε, 17.2 ± 3.5% for ε, and 1.8 ± 0.4, - 2.0 ± 0.5, - 2.3 ± 0.6 s for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller ε, SR, ε and SR than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS).
CONCLUSIONS
Novel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.
背景
异常的左心房（LA）功能是心脏功能障碍和不良心血管结局的标志物，但难以评估，因此未常规量化。我们旨在确定使用标准心血管磁共振（CMR）测量长轴 LA 应变和应变率（SR）的快速方法的可行性和有效性，与传统的特征追踪（FT）衍生的纵向应变相比。
方法
我们研究了 50 名正常对照者、30 名肥厚型心肌病患者和 100 名心力衰竭（HF）患者，包括 40 名射血分数降低（HFrEF）患者、30 名射血分数中间范围（HFmrEF）患者和 30 名射血分数保留（HFpEF）患者。LA 纵向应变和 SR 参数是通过在标准电影 CMR 二腔和四腔视图上跟踪左房室结与左心房后中部 LA 壁上的用户定义点之间的距离来获得的。在三个不同的心脏阶段分析 LA 性能：储备功能（储备应变 ε 和应变率 SR）、导管功能（导管应变 ε 和应变率 SR）和助推泵功能（助推应变 ε 和应变率 SR）。
结果
使用快速和传统的 FT-CMR 方法评估 LA 纵向应变和 SR 之间具有良好的一致性（r = 0.89 至 0.99，p < 0.001）。与 FT-CMR 相比，快速应变和 SR 具有更好的观察者内和观察者间可重复性，评估时间缩短 55%（85 ± 10 与 190 ± 12 s，p < 0.001）。正常对照者的快速 LA 测量值为 ε 为 35.3 ± 5.2%，ε 为 18.1 ± 4.3%，ε 为 17.2 ± 3.5%，相应的相 SR 分别为 1.8 ± 0.4、-2.0 ± 0.5、-2.3 ± 0.6 s。与正常对照组相比，所有患者组的 LA 应变和 SR 均显著降低。HFpEF 和 HFmrEF 患者的 ε、SR、ε 和 SR 明显小于肥厚型心肌病患者，HFmrEF 的 LA 储备和助推功能明显受损与 HFpEF 相比。快速 LA 应变和 SR 与 FT-CMR 相似，可用于区分患者与对照者（曲线下面积（AUC）= 0.79 至 0.96 与 0.76 至 0.93，p = NS）。
结论
从常规电影 CMR 图像中获得的新型定量 LA 应变和 SR 是 LA 时相功能分析的快速可评估参数。
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