Kinoshita Masaki, Tanabe Yuki, Yoshida Kazuki, Kurata Akira, Kobayashi Yusuke, Uetani Teruyoshi, Inoue Katsuji, Nishimura Kazuhisa, Ikeda Shuntaro, Mochizuki Teruhito, Kido Teruhito, Yamaguchi Osamu
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Heart Vessels. 2022 Jan;37(1):31-39. doi: 10.1007/s00380-021-01901-3. Epub 2021 Jul 7.
Computed tomography (CT)-derived three-dimensional maximum principal strain (MP-strain) can provide incremental value to coronary CT angiography for cardiac dysfunction assessment with high diagnostic performance in patients with myocardial infarction. Global longitudinal strain (GLS) measured using two-dimensional speckle tracking echocardiography (2D-STE) is more sensitive than left ventricular ejection fraction (LVEF) for detecting early myocardial dysfunction. We aimed to compare CT-derived MP-strain with each of 2D-STE-derived strains (i.e., longitudinal, circumferential, and radial strains), and identify the major determinants of CT-derived MP-strain among 2D-STE-derived strains. We studied 51 patients who underwent cardiac CT and echocardiography. CT images were reconstructed at every 5% (0-95%) of the RR interval. A dedicated workstation was used to analyze CT-derived MP-strain on the 16-segment model. We calculated CT-derived global MP-strain with all the 16 segments on a per patient basis. Pearson's test was used to assess correlations between CT-derived MP-strain and STE-strain at global and segmental levels. The intra-class correlation coefficient for interobserver agreement for CT-derived global MP-strain was 0.98 (95% confidence interval 0.96-0.99). The low-CT-derived global MP-strain group (≤ 0.43) had more patients with LV dysfunction than the high-CT-derived global MP-strain group (> 0.43). CT-derived global MP-strain was associated with STE-GLS (r = 0.738, P < 0.001), global circumferential strain (r = 0.646, P < 0.001), and global radial strain (r = 0.432, P = 0.001). In multivariate analysis, STE-GLS had the strongest association to CT-derived global MP-strain among three directional STE-strains and LVEF by echocardiography (standardized coefficient = - 0.527, P < 0.001). STE-GLS is a major determinant of CT-derived global MP-strain. CT-derived MP-strain may enhance the value of coronary CT angiography by adding functional information to CT-derived LVEF.
计算机断层扫描（CT）衍生的三维最大主应变（MP应变）可为冠状动脉CT血管造影在评估心肌梗死患者心脏功能障碍方面提供增量价值，且具有较高的诊断性能。使用二维斑点追踪超声心动图（2D-STE）测量的整体纵向应变（GLS）在检测早期心肌功能障碍方面比左心室射血分数（LVEF）更敏感。我们旨在比较CT衍生的MP应变与2D-STE衍生的每种应变（即纵向、圆周和径向应变），并确定2D-STE衍生的应变中CT衍生的MP应变的主要决定因素。我们研究了51例接受心脏CT和超声心动图检查的患者。在RR间期的每5%（0-95%）重建CT图像。使用专用工作站在16节段模型上分析CT衍生的MP应变。我们根据每位患者的所有16个节段计算CT衍生的整体MP应变。采用Pearson检验评估CT衍生的MP应变与STE应变在整体和节段水平上的相关性。CT衍生的整体MP应变的观察者间一致性的组内相关系数为0.98（95%置信区间0.96-0.99）。低CT衍生的整体MP应变组（≤0.43）比高CT衍生的整体MP应变组（>0.43）有更多左心室功能障碍患者。CT衍生的整体MP应变与STE-GLS（r = 0.738，P < 0.001）、整体圆周应变（r = 0.646，P < 0.001）和整体径向应变（r = 0.432，P = 0.001）相关。在多变量分析中，在三个方向的STE应变和超声心动图的LVEF中，STE-GLS与CT衍生的整体MP应变的关联最强（标准化系数 = -0.527，P < 0.001）。STE-GLS是CT衍生的整体MP应变的主要决定因素。CT衍生的MP应变可通过向CT衍生的LVEF添加功能信息来提高冠状动脉CT血管造影的价值。
