评估高血压性心脏病的敏感标志物：细胞外体积和心肌应变。
Sensitive marker for evaluation of hypertensive heart disease: extracellular volume and myocardial strain.
机构信息
Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
BMC Cardiovasc Disord. 2020 Jun 15;20(1):292. doi: 10.1186/s12872-020-01553-7.
BACKGROUND
Evaluation of tissue fibrosis and myocardial hypertrophy in left ventricular (LV) remodeling is the basis of post-treatment evaluation of hypertensive heart disease (HHD). Extracellular volume (ECV) and myocardial strain parameters can indirectly reflect the changes of both. Our objective was to analyze the characteristics of ECV and strain parameters in LV myocardium of HHD with varying degrees of systolic dysfunction, and to explore the changes of both after treatment for hypertension.
METHODS
A total of 62 HHD patients were divided into 3 groups according to ejection fraction (EF < 30, 30%≦EF < 50%, EF≧50%). Twenty-one of these patients underwent cardiac magnetic resonance (CMR) reexamination more than six months after receiving antihypertensive medication. The initial T1 time and post-enhancement T1 time of each segment were measured, and the ECV was calculated. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) of LV were measured by cvi42 software, and the differences in CMR parameters between different groups and before and after treatment were compared.
RESULTS
①The mean, basal and middle ECV value of HHD groups with different EF were all higher than that of the control group (P < 0.05), but the difference between HHD groups was not statistically significant. ②With the decrease of EF, the absolute value of both the global or local strain decreased. Strain is related to LVMI and ECV. ③In general, ECV, global RS (GRS) and global CS (GCS) improved after treatment, but the improvement of LS impairment in HHD patients is difficult.
CONCLUSIONS
ECV and myocardial strain parameters are more sensitive to myocardial abnormalities, and ECV, GRS and GCS are more sensitive to treatment. However it is difficult to improve longitudinal strain impairment in HHD patients. ECV and myocardial strain parameters can be used as good makers for long-term monitoring of the efficacy of HHD patients.
背景
评估左心室（LV）重构中的组织纤维化和心肌肥厚是高血压性心脏病（HHD）治疗后评估的基础。细胞外容积（ECV）和心肌应变参数可以间接反映这两者的变化。我们的目的是分析不同程度收缩功能障碍的 HHD 患者 LV 心肌的 ECV 和应变参数特征，并探讨高血压治疗后两者的变化。
方法
根据射血分数（EF < 30、30%≦EF < 50%、EF≧50%）将 62 例 HHD 患者分为 3 组。其中 21 例患者在接受降压药物治疗 6 个月以上后进行了心脏磁共振（CMR）复查。测量各节段的初始 T1 时间和增强后 T1 时间，并计算 ECV。采用 cvi42 软件测量 LV 径向应变（RS）、周向应变（CS）和纵向应变（LS），比较不同组间及治疗前后 CMR 参数的差异。
结果
①不同 EF 的 HHD 组的平均、基底和中段 ECV 值均高于对照组（P < 0.05），但 HHD 组之间的差异无统计学意义。②随着 EF 的降低，整体或局部应变的绝对值均降低。应变与 LVMI 和 ECV 相关。③一般来说，ECV、整体 RS（GRS）和整体 CS（GCS）在治疗后有所改善，但 HHD 患者 LS 损伤的改善较为困难。
结论
ECV 和心肌应变参数对心肌异常更为敏感，ECV、GRS 和 GCS 对治疗更为敏感。然而，改善 HHD 患者的纵向应变损伤较为困难。ECV 和心肌应变参数可作为长期监测 HHD 患者疗效的良好标志物。
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