Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shennan Middle Road 3025, Shenzhen, China.
Eur Radiol. 2021 Sep;31(9):7098-7109. doi: 10.1007/s00330-021-07752-w. Epub 2021 Feb 24.
Our study aimed to evaluate myocardial strain and tissue characteristics by multiparametric cardiovascular magnetic resonance (CMR) imaging in end-stage renal disease (ESRD) patients on peritoneal dialysis with preserved left ventricular ejection fraction (LVEF).
ESRD patients on peritoneal dialysis with echocardiographic LVEF > 50% and age- and sex-matched healthy volunteers underwent multiparametric CMR at 3 T. LV function, LV myocardial native T1 and T2, and biventricular strain were measured and compared between the patients and controls. Associations of LV myocardial mass index (LVMI) with tissue characterization and strain were evaluated by multiple linear regression.
A total of 65 subjects (42 healthy volunteers and 23 ESRD patients) were enrolled. ESRD group demonstrated larger LVMI, higher native T1 and T2 (1301.9 ± 30.6 ms, 44.6 ± 2.6 ms) than those of the control group (1255.8 ± 45.2 ms, 40.5 ± 1.6 ms; both p < 0.001). Decreased LV strain and increased right ventricular circumferential strain were observed in the ESRD group. In ESRD patients with normal diastolic function on echocardiography, native T1 and T2 values were higher than those of the control group (p = 0.006, p = 0.001). Increased LVMI was associated with increased native T1 (p = 0.001) and T2 value (p < 0.001) after adjusting for age and sex. Increased myocardial native T1 value was associated with reduced LV strain after adjusting age, sex, and LVMI.
ESRD patients on peritoneal dialysis with preserved LVEF demonstrated higher myocardial mass, higher native T1 and T2 values, decreased LV strain, and increased RVGCS compared with healthy controls. Increased myocardial T1 and T2 were found in ESRD even when no systolic or diastolic dysfunction was detected by routine echocardiography.
• Even with preserved LVEF and no known cardiovascular diseases, ESRD patients on peritoneal dialysis demonstrated elevated myocardial T1 and T2 values and decreased left ventricular strain. • Subclinical changes in myocardial tissue composition may exist in ESRD patients on peritoneal dialysis even when no systolic or diastolic dysfunction was detected by routine echocardiography based on ejection fraction, left atrium size, and tissue Doppler. • Right ventricular free wall strain could be enhanced in response to subclinical LV systolic dysfunction in ESRD patients on peritoneal dialysis with preserved LVEF at an early stage.
本研究旨在通过多参数心血管磁共振（CMR）成像评估左心室射血分数（LVEF）保留的终末期肾病（ESRD）腹膜透析患者的心肌应变和组织特征。
在 3T 下，对 LVEF＞50%且年龄和性别匹配的 ESRD 腹膜透析患者和健康志愿者进行多参数 CMR。测量并比较患者和对照组的左心室功能、左心室心肌固有 T1 和 T2 以及双心室应变。通过多元线性回归评估左心室心肌质量指数（LVMI）与组织特征和应变的相关性。
共纳入 65 名受试者（42 名健康志愿者和 23 名 ESRD 患者）。ESRD 组的 LVMI、固有 T1 和 T2（1301.9±30.6ms、44.6±2.6ms）大于对照组（1255.8±45.2ms、40.5±1.6ms；均 P＜0.001）。ESRD 组的左心室应变降低，右心室环向应变增加。在超声心动图表现为正常舒张功能的 ESRD 患者中，固有 T1 和 T2 值高于对照组（P=0.006，P=0.001）。调整年龄和性别后，LVMI 与固有 T1（P=0.001）和 T2 值（P＜0.001）增加相关。调整年龄、性别和 LVMI 后，固有 T1 值升高与左心室应变降低相关。
保留 LVEF 的腹膜透析 ESRD 患者与健康对照组相比，心肌质量更高，固有 T1 和 T2 值更高，左心室应变降低，右心室环向应变增加。即使通过常规超声心动图未检测到收缩或舒张功能障碍，也发现 ESRD 患者存在心肌 T1 和 T2 升高。
即使保留了 LVEF，且没有已知的心血管疾病，腹膜透析的 ESRD 患者也表现出心肌 T1 和 T2 值升高和左心室应变降低。
基于射血分数、左心房大小和组织多普勒，即使根据射血分数、左心房大小和组织多普勒未检测到收缩或舒张功能障碍，腹膜透析的 ESRD 患者也可能存在心肌组织成分的亚临床变化。
在保留 LVEF 的 ESRD 腹膜透析患者中，即使左心室收缩功能障碍处于亚临床阶段，右心室游离壁应变也可能增强。
