Kermer Josephine, Traber Julius, Utz Wolfgang, Hennig Pierre, Menza Marius, Jung Bernd, Greiser Andreas, Barckow Philipp, von Knobelsdorff-Brenkenhoff Florian, Töpper Agnieszka, Blaszczyk Edyta, Schulz-Menger Jeanette
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany.
Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
ESC Heart Fail. 2020 Oct;7(5):2637-2649. doi: 10.1002/ehf2.12846. Epub 2020 Jul 20.
Heart failure with preserved ejection fraction is still a diagnostic and therapeutic challenge, and accurate non-invasive diagnosis of left ventricular (LV) diastolic dysfunction (DD) remains difficult. The current study aimed at identifying the most informative cardiovascular magnetic resonance (CMR) parameters for the assessment of LVDD.
We prospectively included 50 patients and classified them into three groups: with DD (DD+, n = 15), without (DD-, n = 26), and uncertain (DD±, n = 9). Diagnosis of DD was based on echocardiographic E/E', invasive LV end-diastolic pressure, and N-terminal pro-brain natriuretic peptide. CMR was performed at 1.5 T to assess LV and left atrial (LA) morphology, LV diastolic strain rate (SR) by tissue tracking and tagging, myocardial peak velocities by tissue phase mapping, and transmitral inflow profile using phase contrast techniques. Statistics were performed only on definitive DD+ and DD- (total number 41). DD+ showed enlarged LA with LA end-diastolic volume/height performing best to identify DD+ with a cut-off value of ≥0.52 mL/cm (sensitivity = 0.71, specificity = 0.84, and area under the receiver operating characteristic curve = 0.75). DD+ showed significantly reduced radial (inferolateral E peak: DD-: -14.5 ± 6.5%/s vs. DD+: -10.9 ± 5.9%/s, P = 0.04; anterolateral A peak: DD-: -4.2 ± 1.6%/s vs. DD+: -3.1 ± 1.4%/s, P = 0.04) and circumferential (inferolateral A peak: DD-: 3.8 ± 1.2%/s vs. DD+: 2.8 ± 0.8%/s, P = 0.007; anterolateral A peak: DD-: 3.5 ± 1.2%/s vs. DD+: 2.5 ± 0.8%/s, P = 0.048) SR in the basal lateral wall assessed by tissue tracking. In the same segments, DD+ showed lower peak myocardial velocity by tissue phase mapping (inferolateral radial peak: DD-: -3.6 ± 0.7 ms vs. DD+: -2.8 ± 1.0 ms, P = 0.017; anterolateral longitudinal peak: DD-: -5.0 ± 1.8 ms vs. DD+: -3.4 ± 1.4 ms, P = 0.006). Tagging revealed reduced global longitudinal SR in DD+ (DD-: 45.8 ± 12.0%/s vs. DD+: 34.8 ± 9.2%/s, P = 0.022). Global circumferential and radial SR by tissue tracking and tagging, LV morphology, and transmitral flow did not differ between DD+ and DD-.
Left atrial size and regional quantitative myocardial deformation applying CMR identified best patients with DD.
射血分数保留的心力衰竭仍然是诊断和治疗上的挑战，准确无创诊断左心室（LV）舒张功能障碍（DD）仍然困难。本研究旨在确定评估LVDD最具信息量的心血管磁共振（CMR）参数。
我们前瞻性纳入了50例患者，并将他们分为三组：有舒张功能障碍（DD+，n = 15）、无舒张功能障碍（DD-，n = 26）和不确定（DD±，n = 9）。DD的诊断基于超声心动图E/E'、有创LV舒张末期压力和N末端脑钠肽前体。在1.5 T下进行CMR以评估LV和左心房（LA）形态、通过组织追踪和标记评估LV舒张应变率（SR）、通过组织相位映射评估心肌峰值速度以及使用相位对比技术评估二尖瓣流入剖面。仅对明确的DD+和DD-（总数41例）进行统计分析。DD+组显示LA增大，LA舒张末期容积/身高在识别DD+方面表现最佳，截断值≥0.52 mL/cm（敏感性 = 0.71，特异性 = 0.84，受试者工作特征曲线下面积 = 0.75）。通过组织追踪评估，DD+组基底侧壁的径向（下外侧E峰：DD-组：-14.5±6.5%/s vs. DD+组：-10.9±5.9%/s，P = 0.04；前外侧A峰：DD-组：-4.2±1.6%/s vs. DD+组：-3.1±1.4%/s，P = 0.04）和圆周（下外侧A峰：DD-组：3.8±1.2%/s vs. DD+组：2.8±0.8%/s，P = 0.007；前外侧A峰：DD-组：3.5±1.2%/s vs. DD+组：2.5±0.8%/s）SR显著降低。在相同节段，通过组织相位映射，DD+组显示心肌峰值速度较低（下外侧径向峰值：DD-组：-3.6±0.7 ms vs. DD+组：-2.8±1.0 ms，P = 0.017；前外侧纵向峰值：DD-组：-5.0±1.8 ms vs. DD+组：-3.4±1.4 ms，P = 0.006）。标记显示DD+组整体纵向SR降低（DD-组：45.8±12.0%/s vs. DD+组：34.8±9.2%/s，P = 0.022）。通过组织追踪和标记得到的整体圆周和径向SR、LV形态以及二尖瓣血流在DD+和DD-组之间无差异。
应用CMR测量的左心房大小和局部定量心肌变形最有助于识别DD患者。
