应用心脏双能量 CT 结合迟发碘增强技术对无冠心病心力衰竭患者心肌细胞外容积分数的定量检测：一项单中心前瞻性研究。
Myocardial extracellular volume fraction quantitation using cardiac dual-energy CT with late iodine enhancement in patients with heart failure without coronary artery disease: A single-center prospective study.
机构信息
Department of Radiology, First Affiliated Hospital of Soochow University, Shizi Street No.188, Suzhou, 215002, China; Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
出版信息
Eur J Radiol. 2021 Jul;140:109743. doi: 10.1016/j.ejrad.2021.109743. Epub 2021 May 1.
PURPOSE
To evaluate the relationship between myocardial extracellular volume (ECV) fraction measured using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and risk of heart failure (HF) in patients without coronary artery disease (CAD), and to evaluate the relationship between ECV and left ventricular structure and function.
MATERIALS AND METHODS
Sixty consecutive HF patients without CAD and 60 consecutive participants without heart disease who underwent coronary CT angiography (CCTA) following LIE-DECT were included. ECV of the left ventricle was calculated from the iodine maps and hematocrit levels using the American Heart Association (AHA) 16-segment model. Cardiac structural and functional parameters were collected including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), interventricular septal thickness (IVST), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP).
RESULTS
ECV in HF patients without CAD (31.3 ± 4.0 %) was significantly higher than that in healthy subjects (27.1 ± 3.7 %) (P < 0.001). Multivariate linear analysis revealed that ECV was associated with age (β = 0.098, P = 0.010) and hypertension (β = 2.093, P = 0.011) in all participants. Binary logistic regression analysis showed that after adjusting for age, sex, body mass index (BMI), smoking, and drinking, ECV was a risk factor affecting the occurrence of HF in those without CAD (OR = 1.356, 95 %CI：1.178-1.561, P < 0.001). A positive correlation was found between ECV and NT-pro-BNP, LVEDV, LVESV, and LAV (r = 0.629, 0.329, 0.346, and 0.338, respectively; all P < 0.001) in all participants.
CONCLUSIONS
ECV could be measured using LIE-DECT iodine maps. ECV elevation was a risk factor for HF without CAD and correlated with cardiac structure and function.
目的
利用双能量计算机断层扫描（DECT）测量的心肌细胞外容积（ECV）分数与无冠状动脉疾病（CAD）的心力衰竭（HF）患者的 HF 风险之间的关系，并评估 ECV 与左心室结构和功能之间的关系。
材料和方法
本研究共纳入 60 例连续的无 CAD 的 HF 患者和 60 例连续的行 LIE-DECT 后行冠状动脉 CT 血管造影（CCTA）的无心脏病参与者。采用美国心脏协会（AHA）16 节段模型从碘图和血细胞比容水平计算左心室的 ECV。收集心脏结构和功能参数，包括左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）、左心室射血分数（LVEF）、左心房容积（LAV）、室间隔厚度（IVST）和 N 末端脑钠肽前体（NT-pro-BNP）。
结果
无 CAD 的 HF 患者的 ECV（31.3±4.0%）明显高于健康受试者（27.1±3.7%）（P<0.001）。多变量线性分析显示，ECV 与年龄（β=0.098，P=0.010）和高血压（β=2.093，P=0.011）在所有参与者中相关。二元逻辑回归分析显示，在调整年龄、性别、体重指数（BMI）、吸烟和饮酒因素后，ECV 是影响无 CAD 患者 HF 发生的危险因素（OR=1.356，95%CI：1.178-1.561，P<0.001）。在所有参与者中，ECV 与 NT-pro-BNP、LVEDV、LVESV 和 LAV 呈正相关（r=0.629、0.329、0.346 和 0.338，均 P<0.001）。
结论
可以使用 LIE-DECT 碘图测量 ECV。ECV 升高是无 CAD 的 HF 的危险因素，并与心脏结构和功能相关。
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