肥厚型心肌病左心室射血分数保留的心力衰竭与左心房相功能障碍的相关性：心脏 MRI 斑点追踪的评估。

Association Between Heart Failure With Preserved Left Ventricular Ejection Fraction and Impaired Left Atrial Phasic Function in Hypertrophic Cardiomyopathy: Evaluation by Cardiac MRI Feature Tracking.

机构信息

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

J Magn Reson Imaging. 2022 Jul;56(1):248-259. doi: 10.1002/jmri.28000. Epub 2021 Nov 19.

DOI:10.1002/jmri.28000

PMID:34799953

Abstract

BACKGROUND

The majority of heart failure (HF) in hypertrophic cardiomyopathy (HCM) manifests as a phenotype with preserved left ventricular (LV) ejection fraction; however, the exact contribution of left atrial (LA) phasic function to HF with preserved ejection fraction (HFpEF) in HCM remains unresolved.

PURPOSE

To define the association between LA function and HFpEF in HCM patients using cardiac magnetic resonance imaging (MRI) feature tracking.

STUDY TYPE

Retrospective.

POPULATION

One hundred and fifty-four HCM patients (HFpEF vs. non-HF: 55 [34 females] vs. 99 [43 females]).

FIELD STRENGTH/SEQUENCE: 3.0 T/balanced steady-state free precession.

ASSESSMENT

LA reservoir function (reservoir strain [ε ], total ejection fraction [EF]), conduit function (conduit strain [ε ], passive EF), booster-pump function (booster strain [ε ] and active EF), LA volume index, and LV global longitudinal strain (LV GLS) were evaluated in HCM patients.

STATISTICAL TESTS

Chi-square test, Student's t-test, Mann-Whitney U test, multivariate linear regression, logistic regression, and net reclassification analysis were used. Two-sided P < 0.05 was considered statistically significant.

RESULTS

No significant difference was found in LV GLS between the non-HF and HFpEF group (-10.67 ± 3.14% vs. -10.14 ± 4.01%, P = 0.397), whereas the HFpEF group had more severely impaired LA phasic strain (ε : 27.40 [22.60, 35.80] vs. 18.15 [11.98, 25.90]; ε : 13.80 [9.20, 18.90] vs. 7.95 [4.30, 14.35]; ε : 13.50 [9.90, 17.10] vs. 7.90 [5.40, 14.15]). LA total EF (37.91 [29.54, 47.94] vs. 47.49 [39.18, 55.01]), passive EF (14.70 [7.41, 21.49] vs. 18.07 [9.32, 24.78]), and active EF (27.19 [17.79, 36.60] vs. 36.64 [26.63, 42.71]) were all significantly decreased in HFpEF patients compared with non-HF patients. LA reservoir (β = 0.90 [0.85, 0.96]), conduit (β = 0.93 [0.87, 0.99]), and booster (β = 0.86 [0.78, 0.95]) strain were independently associated with HFpEF in HCM patients. The model including reservoir strain (Net Reclassification Index [NRI]: 0.260) or booster strain (NRI: 0.325) improved the reclassification of HFpEF based on LV GLS and minimum left atrial volume index (LAVI ).

DATA CONCLUSION

LA phasic function was severely impaired in HCM patients with HFpEF, whereas LV function was not further impaired compared with non-HF patients.

LEVEL OF EVIDENCE

4 TECHNICAL EFFICACY: Stage 3.

摘要

背景

大多数肥厚型心肌病（HCM）心力衰竭（HF）表现为左心室射血分数保留的表型；然而，左心房（LA）相功能对 HCM 保留射血分数心力衰竭（HFpEF）的确切贡献仍未解决。

目的

使用心脏磁共振成像（MRI）特征追踪技术定义 HCM 患者中 LA 功能与 HFpEF 的相关性。

研究类型

回顾性。

人群

154 名 HCM 患者（HFpEF 与非-HF：55[34 名女性]与 99[43 名女性]）。

磁场强度/序列：3.0T/平衡稳态自由进动。

评估

在 HCM 患者中评估 LA 储液器功能（储液器应变[ε]，总射血分数[EF]）、导管功能（导管应变[ε]，被动 EF）、助推器泵功能（助推器应变[ε]和主动 EF）、LA 容积指数和左心室整体纵向应变（LV GLS）。

统计检验

卡方检验、学生 t 检验、Mann-Whitney U 检验、多元线性回归、逻辑回归和净重新分类分析。双侧 P<0.05 被认为具有统计学意义。

结果

非-HF 和 HFpEF 组之间的 LV GLS 没有显著差异（-10.67±3.14%与-10.14±4.01%，P=0.397），而 HFpEF 组的 LA 相应变明显受损（ε：27.40[22.60，35.80]与 18.15[11.98，25.90]；ε：13.80[9.20，18.90]与 7.95[4.30，14.35]；ε：13.50[9.90，17.10]与 7.90[5.40，14.15]）。LA 总 EF（37.91[29.54，47.94]与 47.49[39.18，55.01]）、被动 EF（14.70[7.41，21.49]与 18.07[9.32，24.78]）和主动 EF（27.19[17.79，36.60]与 36.64[26.63，42.71]）在 HFpEF 患者中均显著低于非-HF 患者。LA 储液器（β=0.90[0.85，0.96]）、导管（β=0.93[0.87，0.99]）和助推器（β=0.86[0.78，0.95]）应变与 HCM 患者的 HFpEF 独立相关。包括储液器应变（净重新分类指数[NRI]：0.260）或助推器应变（NRI：0.325）的模型改善了基于 LV GLS 和最小左心房容积指数（LAVI）的 HFpEF 的重新分类。