Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt.
Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt.
J Magn Reson Imaging. 2021 Nov;54(5):1476-1485. doi: 10.1002/jmri.27700. Epub 2021 May 26.
Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Reduction in left ventricular ejection fraction (LVEF) represents late left ventricle (LV) dysfunction. Cardiac MRI myocardial strain analysis is an alternative method for assessment of LV function.
To investigate whether LV strain analysis is more sensitive than LVEF for early detection of systolic dysfunction in children with ESRD.
Case control.
Thirty-two children with ESRD (median 14 years, 17 females) and 10 healthy control (median 12.5 years, 7 females).
A 1.5 T /retrospective ECG-gated steady-state free precession (SSFP).
LVEF, and indexed LV mass (LVMi) and LV end-diastolic volume (LVEDVi) were measured. Using tissue tracking analysis, LV endocardial and epicardial contours were traced in short and long axes at end diastole to calculate global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains.
Cardiac MRI and strain parameters were compared between patients and control, and between subgroup with preserved LVEF and control by Student t-test/Mann Whitney test. Diagnostic accuracy was assessed by Receiver operating characteristic analysis. Strain as predictor of poor outcome (mortality, pulmonary edema, and/or heart failure) within 1-year follow up was investigated by binary logistic regression.
Compared to control, cardiac MRI LVEF, LVEDVi, LVMi, GLS, GCS and GRS were significantly impaired in patients. Patients with preserved LVEF had significantly higher LVEDVi, LVMi and significantly impaired GCS and GRS than control. Strain parameters were significantly correlated with LVEF, LVEDVi, and LVMi. GCS and GRS demonstrated greater diagnostic accuracy than GLS (area under curve: 0.89). LVEF, LVMi, GCS, and GRS were correlated with poor outcome.
Cardiac MRI tissue tracking could identify subclinical LV dysfunction in children with ESRD and still preserved LVEF. Furthermore, LV strain parameters (GCS and GRS) were correlated with future cardiovascular events.
2 TECHNICAL EFFICACY: Stage 2.
心血管疾病是终末期肾病（ESRD）患者发病率和死亡率的主要原因。左心室射血分数（LVEF）降低代表晚期左心室（LV）功能障碍。心脏 MRI 心肌应变分析是评估 LV 功能的替代方法。
研究 LV 应变分析是否比 LVEF 更能早期发现 ESRD 儿童的收缩功能障碍。
病例对照。
32 名 ESRD 患儿（中位数 14 岁，17 名女性）和 10 名健康对照（中位数 12.5 岁，7 名女性）。
1.5T/回顾性心电图门控稳态自由进动（SSFP）。
测量 LVEF 以及指数化 LV 质量（LVMi）和 LV 舒张末期容积（LVEDVi）。使用组织追踪分析，在舒张末期在心内膜和心外膜短轴和长轴上追踪 LV 轮廓，以计算整体纵向（GLS）、圆周（GCS）和径向（GRS）应变。
通过学生 t 检验/曼惠特尼检验比较患者与对照组以及 LVEF 保留亚组与对照组之间的心脏 MRI 和应变参数。通过接受者操作特征分析评估诊断准确性。通过二元逻辑回归研究 1 年内随访期间应变作为不良结局（死亡率、肺水肿和/或心力衰竭）的预测因子。
与对照组相比，患者的心脏 MRI LVEF、LVEDVi、LVMi、GLS、GCS 和 GRS 均显著受损。LVEF 保留的患者的 LVEDVi、LVMi 显著升高，GCS 和 GRS 显著受损。应变参数与 LVEF、LVEDVi 和 LVMi 显著相关。GCS 和 GRS 的诊断准确性优于 GLS（曲线下面积：0.89）。LVEF、LVMi、GCS 和 GRS 与不良预后相关。
心脏 MRI 组织追踪可以在 LVEF 仍保留的 ESRD 儿童中识别亚临床 LV 功能障碍。此外，LV 应变参数（GCS 和 GRS）与未来心血管事件相关。
2 级技术功效：2 级。
