双叶二尖瓣脱垂患者的心肌应变特征追踪分析：与 LGE 和心律失常的关系。
Feature tracking myocardial strain analysis in patients with bileaflet mitral valve prolapse: relationship with LGE and arrhythmias.
机构信息
Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy.
Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
出版信息
Eur Radiol. 2021 Oct;31(10):7273-7282. doi: 10.1007/s00330-021-07876-z. Epub 2021 Apr 19.
OBJECTIVES
Anatomical substrate and mechanical trigger co-act in arrhythmia's onset in patients with bileaflet mitral valve prolapse (bMVP). Feature tracking (FT) may improve risk stratification provided by cardiac magnetic resonance (CMR). The aim was to investigate differences in CMR and FT parameters in bMVP patients with and without complex arrhythmias (cVA and no-cVA).
METHODS
In this retrospective study, 52 patients with bMVP underwent 1.5 T CMR and were classified either as no-cVA (n = 32; 12 males; 49.6 ± 17.4 years) or cVA (n = 20; 3 males; 44.7 ± 11.2 years), the latter group including 6 patients (1 male; 45.7 ± 12.7 years) with sustained ventricular tachycardia or ventricular fibrillation (SVT-FV). Twenty-four healthy volunteers (11 males, 36.2 ± 12.5 years) served as control. Curling, prolapse distance, mitral annulus disjunction (MAD), and late gadolinium enhancement (LGE) were recorded and CMR-FT analysis performed. Statistical analysis included non-parametric tests and binary logistic regression.
RESULTS
LGE and MAD distance were associated with cVA with an odds ratio (OR) of 8.51 for LGE (95% CI 1.76, 41.28; p = 0.008) and of 1.25 for MAD (95% CI 1.02, 1.54; p = 0.03). GLS 2D (- 11.65 ± 6.58 vs - 16.55 ± 5.09 1/s; p = 0.04), PSSR longitudinal 2D (0.04 ± 1.62 1/s vs - 1.06 ± 0.35 1/s; p = 0.0001), and PSSR radial 3D (3.95 ± 1.97 1/s vs 2.64 ± 1.03 1/s; p = 0.0001) were different for SVT-VF versus the others. PDSR circumferential 2D (1.10 ± 0.54 vs. 0.84 ± 0.34 1/s; p = 0.04) and 3D (0.94 ± 0.42 vs. 0.69 ± 0.17 1/s; p = 0.04) differed between patients with and without papillary muscle LGE.
CONCLUSIONS
CMR-FT allowed identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT-VF. LGE and MAD distance were associated with cVA.
KEY POINTS
• CMR-FT allows identifying several subtle myocardial deformation abnormalities in bMVP patients, especially those involving the papillary muscle. • CMR-FT allows identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT and VF. • In patients with bMVP, the stronger predictor of cVA is LGE (OR = 8.51; 95% CI 1.76, 41.28; p = 0.008), followed by MAD distance (OR = 1.25; 95% CI 1.02, 1.54; p = 0.03).
目的
解剖学基础和机械触发共同作用于二尖瓣前叶脱垂（bMVP）患者心律失常的发生。特征追踪（FT）可能通过心脏磁共振（CMR）提高风险分层。目的是研究伴有和不伴有复杂心律失常（cVA 和 no-cVA）的 bMVP 患者的 CMR 和 FT 参数的差异。
方法
本回顾性研究纳入了 52 名 bMVP 患者，行 1.5 T CMR 检查，并分为无复杂心律失常（n = 32；12 名男性；49.6 ± 17.4 岁）或复杂心律失常（n = 20；3 名男性；44.7 ± 11.2 岁）。后者包括 6 名（1 名男性；45.7 ± 12.7 岁）持续性室性心动过速或室颤（SVT-FV）患者。24 名健康志愿者（11 名男性，36.2 ± 12.5 岁）作为对照组。记录二尖瓣瓣环卷曲、脱垂距离、瓣环分离（MAD）和晚期钆增强（LGE），并进行 CMR-FT 分析。统计分析包括非参数检验和二元逻辑回归。
结果
LGE 和 MAD 距离与 cVA 相关，LGE 的优势比（OR）为 8.51（95% CI 1.76，41.28；p = 0.008），MAD 的 OR 为 1.25（95% CI 1.02，1.54；p = 0.03）。二维整体纵向应变（GLS 2D）（-11.65 ± 6.58 比-16.55 ± 5.09 1/s；p = 0.04）、二维节段纵向应变率（PSSR）（0.04 ± 1.62 1/s 比-1.06 ± 0.35 1/s；p = 0.0001）和三维径向应变率（PSSR）（3.95 ± 1.97 1/s 比 2.64 ± 1.03 1/s；p = 0.0001）在 SVT-VF 患者中与其他患者不同。二维圆周应变率（PDSR）（1.10 ± 0.54 比 0.84 ± 0.34 1/s；p = 0.04）和三维圆周应变率（0.94 ± 0.42 比 0.69 ± 0.17 1/s；p = 0.04）在有和无乳头肌 LGE 的患者之间存在差异。
结论
CMR-FT 可识别 bMVP 患者发生 SVT-VF 风险的细微心肌变形异常。LGE 和 MAD 距离与 cVA 相关。
关键点
CMR-FT 可识别 bMVP 患者存在的多种细微心肌变形异常，尤其是涉及乳头肌的异常。
CMR-FT 可识别 bMVP 患者发生 SVT 和 VF 的风险存在的细微心肌变形异常。
在 bMVP 患者中，cVA 更强的预测因子是 LGE（OR = 8.51；95% CI 1.76，41.28；p = 0.008），其次是 MAD 距离（OR = 1.25；95% CI 1.02，1.54；p = 0.03）。
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