川崎病患者左心室收缩功能障碍与冠状动脉扩张的关系：心血管磁共振评估。

Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients: Assessment with cardiovascular magnetic resonance.

机构信息

Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Department of Radiology, Chengdu Fifth People's Hospital, 33 Ma Shi Street, Wenjiang District, Chengdu, Sichuan 611130, PR China.

出版信息

Eur J Radiol. 2021 Dec;145:110039. doi: 10.1016/j.ejrad.2021.110039. Epub 2021 Nov 16.

DOI:10.1016/j.ejrad.2021.110039

PMID:34818610

Abstract

PURPOSE

To quantify global and regional left ventricular (LV) strain parameters in patients with Kawasaki disease (KD) using cardiovascular magnetic resonance (CMR) tissue tracking and assess the association of coronary artery dilation (CA dilation) with LV systolic dysfunction.

METHODS

Thirty-one KD patients with CA dilation, 22 patients without CA dilation and 27 age- and sex-matched normal controls underwent 3.0 T CMR examination. Z score of >2 was defined as CA dilation. Global LV strain parameters and regional LV strain parameters in 16 American Heart Association segmentation, including radial, circumferential and longitudinal peak strain (PS) and LV function were measured and compared among groups.

RESULTS

No significant difference in LV ejection fraction has been observed among controls, KD patients with CA dilation and without CA dilation (all p > 0.05). However, global longitudinal PS (GLPS) was lower in groups with CA dilation than those without CA dilation (-12.6 ± 4.1% vs -14.9 ± 2.6%, p < 0.05). For regional strain parameters, the segments with CA dilation (n = 301) were lower than those in both normal controls (n = 416) and segments without CA dilation (n = 547) in regional radial, circumferential and longitudinal PS (all p < 0.05). The severity of CA dilation was positively correlated to GLPS and regional longitudinal PS (r = 0.388 and r = 0.222; both p < 0.05) in KD patients. After adjusting for clinical characteristics, the multivariate analysis demonstrated that Z score was independently associated with GLPS in KD patients (β = 0.469, p = 0.000, model R = 0.355).

CONCLUSIONS

CMR tissue tracking could sensitively identify subclinical LV dysfunction in KD patients with CA dilation. LV systolic dysfunction occurs particularly in the myocardium dominated by the dilated coronary artery. CA dilation is an independent predictor of LV systolic dysfunction.

摘要

目的

使用心血管磁共振（CMR）组织追踪技术量化川崎病（KD）患者的整体和局部左心室（LV）应变参数，并评估冠状动脉扩张（CA 扩张）与 LV 收缩功能障碍的相关性。

方法

31 例 CA 扩张的 KD 患者、22 例无 CA 扩张的 KD 患者和 27 名年龄和性别匹配的正常对照者接受了 3.0T CMR 检查。Z 评分>2 定义为 CA 扩张。在各组间比较和测量 16 个美国心脏协会分段的整体 LV 应变参数和局部 LV 应变参数，包括径向、周向和纵向峰值应变（PS）和 LV 功能。

结果

在对照组、CA 扩张的 KD 患者和无 CA 扩张的 KD 患者之间，LV 射血分数无显著差异（均 P>0.05）。然而，CA 扩张组的整体纵向 PS（GLPS）低于无 CA 扩张组（-12.6±4.1%比-14.9±2.6%，P<0.05）。对于局部应变参数，有 CA 扩张的节段（n=301）的径向、周向和纵向 PS 均低于正常对照组（n=416）和无 CA 扩张的节段（n=547）（均 P<0.05）。KD 患者的 CA 扩张严重程度与 GLPS 和局部纵向 PS 呈正相关（r=0.388 和 r=0.222；均 P<0.05）。在校正临床特征后，多元分析表明，Z 评分与 KD 患者的 GLPS 独立相关（β=0.469，P=0.000，模型 R=0.355）。