三维斑点追踪技术与二维应变技术评价终末期心力衰竭患者右心室心肌纤维化的比较
3-Dimensional Versus 2-Dimensional STE for Right Ventricular Myocardial Fibrosis in Patients With End-Stage Heart Failure.
机构信息
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
JACC Cardiovasc Imaging. 2021 Jul;14(7):1309-1320. doi: 10.1016/j.jcmg.2021.01.015. Epub 2021 Mar 17.
BACKGROUND
Longitudinal strain of the right ventricular (RV) free wall (RVFWLS) assessed by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been recently demonstrated to correlate with the extent of RV myocardial fibrosis (MF). However, the value of 3-dimensional (3D) STE-derived strain parameters in predicting RV MF has not been investigated in patients with end-stage heart failure (HF).
OBJECTIVES
This study aimed to determine which RV strain parameter assessed by 2D-STE and 3D-STE was the most reliable parameter for predicting RV MF in patients with end-stage HF against histological confirmation of MF.
METHODS
A total of 105 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in our study. The conventional RV function parameters, 2D-RVFWLS, and 3D-RVFWLS were obtained in these patients. The degree of MF was quantified by Masson trichrome staining in RV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology.
RESULTS
Patients with severe MF had lower 3D-RVFWLS, 2D-RVFWLS, and conventional parameters of RV function compared with those with mild and moderate MF. RV MF strongly correlated with 3D-RVFWLS (r = -0.72; p < 0.001), modestly with 2D-RVFWLS (r = -0.53; p < 0.001), and weakly with conventional RV function parameters (r = -0.21 to -0.49; p < 0.01). 3D-RVFWLS correlated best with the degree of MF (r = -0.72 vs. -0.21 to -0.53; p < 0.05) compared with 2D-RVFWLS and conventional RV function parameters. 3D-RVFWLS had the highest accuracy for detecting severe MF (area under the receiver-operating characteristic curve: 0.90 vs. 0.24-0.80; p < 0.05) compared with 2D-RVFWLS and conventional RV parameters. The model with 3D-RVFWLS (R = 0.63; p < 0.001) was better in predicting the degree of RV MF than that with 2D-RVFWLS (R = 0.54; p < 0.001).
CONCLUSIONS
3D-RVFWLS may be the most robust echocardiographic measure for predicting the extent of RV MF in patients with end-stage HF.
背景
二维斑点追踪超声心动图（STE）评估的右心室（RV）游离壁（RVFWLS）的纵向应变最近已被证明与 RV 心肌纤维化（MF）的程度相关。然而，在终末期心力衰竭（HF）患者中，三维（3D）STE 衍生应变参数预测 RV MF 的价值尚未得到研究。
目的
本研究旨在确定通过二维 STE 和三维 STE 评估的哪种 RV 应变参数在通过组织学证实 MF 的情况下，是预测终末期 HF 患者 RV MF 的最可靠参数。
方法
本研究纳入了 105 例接受心脏移植的终末期 HF 连续患者。这些患者获得了常规 RV 功能参数、二维 RVFWLS 和三维 RVFWLS。通过 RV 心肌样本的 Masson 三色染色定量 MF 程度。根据组织学上 MF 的程度，将研究人群分为 3 组。
结果
与 MF 轻度和中度的患者相比，MF 严重的患者的 3D-RVFWLS、2D-RVFWLS 和常规 RV 功能参数均较低。RV MF 与 3D-RVFWLS 呈强相关（r = -0.72；p < 0.001），与 2D-RVFWLS 呈中度相关（r = -0.53；p < 0.001），与常规 RV 功能参数呈弱相关（r = -0.21 至 -0.49；p < 0.01）。与 2D-RVFWLS 和常规 RV 功能参数相比，3D-RVFWLS 与 MF 程度的相关性最佳（r = -0.72 与 -0.21 至 -0.53；p < 0.05）。3D-RVFWLS 在检测严重 MF 方面具有最高的准确性（接受者操作特征曲线下面积：0.90 与 0.24-0.80；p < 0.05），与 2D-RVFWLS 和常规 RV 参数相比。与 2D-RVFWLS（R = 0.54；p < 0.001）相比，具有 3D-RVFWLS（R = 0.63；p < 0.001）的模型在预测 RV MF 程度方面更好。
结论
3D-RVFWLS 可能是预测终末期 HF 患者 RV MF 程度的最可靠超声心动图指标。
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