Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.
Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
Eur Heart J Cardiovasc Imaging. 2020 Oct 20;21(11):1262-1272. doi: 10.1093/ehjci/jeaa057.
We aimed at directly comparing three-dimensional (3D) and two-dimensional (2D) deformation parameters in hypertrophic hearts and depict which may best reflect underlying fibrosis in hypertrophic cardiomyopathy (HCM), defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
We included 40 HCM [54.1 ± 14.3 years, 82.5% male, maximum wall thickness (MWT) 19.3 ± 4.8 mm] and 15 hypertensive (HTN) patients showing myocardial hypertrophy (58.1 ± 15.6 years, 80% male, MWT 12.8 ± 1.4 mm) who have consecutively undergone 2D-, 3D-speckle tracking echocardiography and LGE CMR. Deformation parameters (2D and 3D) presented overall poor to moderate correlations, with 3D_longitudinal strain (LS) and 3D_circumferential strain (CS) values being constantly higher compared to 2D derivatives. By regression analysis, hypertrophy substrate (HCM vs. hypertension) and hypertrophy magnitude were the parameters to influence 2D-3D LS and CS strain correlations (R2 = 0.66, P < 0.001 and R2 = 0.5, P = 0.001 accordingly). Among segmental deformation indices, 2D_LS showed the best area under the curve [AUC = 0.78, 95% confidence intervals (CI) (0.75-0.81), P < 0.0005] to detect fibrosis, with 3D deformation parameters showing similar AUC (0.65) and 3D_LS presenting the highest specificity [93.1%, 95% CI (90.6-95.1)].
In hypertrophic hearts, 2D and 3D deformation parameters are not interchangeable, showing modest correlations. Thickness, substrate, and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_peak segmental longitudinal strain remains the best strain parameter for tissue characterization and fibrosis detection.
本研究旨在直接比较肥厚型心肌病（HCM）患者中三维（3D）和二维（2D）应变参数，并通过心脏磁共振（CMR）中的钆延迟增强（LGE）来描绘哪些参数可能最能反映肥厚心肌中的纤维化。
本研究纳入了 40 例 HCM 患者（年龄 54.1±14.3 岁，82.5%为男性，最大室壁厚度[MWT]为 19.3±4.8mm）和 15 例高血压（HTN）患者（年龄 58.1±15.6 岁，80%为男性，MWT 为 12.8±1.4mm），这些患者均连续接受了 2D-、3D-斑点追踪超声心动图和 LGE CMR 检查。整体而言，应变参数（2D 和 3D）的相关性较差至中等，3D 纵向应变（LS）和 3D 周向应变（CS）值始终高于 2D 应变。通过回归分析，心肌肥厚的基质（HCM 与 HTN）和心肌肥厚的程度是影响 2D-3D LS 和 CS 应变相关性的参数（R2=0.66，P<0.001 和 R2=0.5，P=0.001）。在节段性应变指标中，2D_LS 显示出最佳的曲线下面积[AUC=0.78，95%置信区间（CI）（0.75-0.81），P<0.0005]来检测纤维化，而 3D 应变参数显示出相似的 AUC（0.65），3D_LS 显示出最高的特异性[93.1%，95%CI（90.6-95.1）]。
在肥厚型心肌中，2D 和 3D 应变参数不可互换，它们之间的相关性中等。厚度、基质和追踪算法的计算假设似乎会导致这种变异性。然而，在 HCM 患者中，2D 峰值节段性纵向应变仍然是组织特征和纤维化检测的最佳应变参数。
