冠心病和屏气受限患者的预后：3.0T 自由呼吸心脏磁共振方案。
Prognosis in patients with coronary heart disease and breath-holding limitations: a free-breathing cardiac magnetic resonance protocol at 3.0 T.
机构信息
MRI Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Siemens Medical Solulations USA, Inc., Los Angeles, USA.
出版信息
BMC Cardiovasc Disord. 2021 Dec 7;21(1):580. doi: 10.1186/s12872-021-02402-x.
BACKGROUND AND PURPOSE
Conventional cardiac magnetic resonance (CCMR) imaging is usually performed with breath-holding (BH), which is adverse in patients with BH limitations. We explored the ability of a free-breathing CMR (fCMR) protocol to prognosticate in patients with coronary heart diseases (CHD) and limited BH ability.
METHODS
Sixty-seven patients with CHD and limited BH abilities were prospectively enrolled in this study. All patients underwent comprehensive fCMR imaging at 3.0 T. The fCMR protocols included compressed sensing (CS) single-shot cine acceleration imaging, and motion-corrected (MOCO), single-shot late gadolinium enhancement (LGE) imaging. Image quality (IQ) of the cine and LGE images was evaluated based on the 5-point Likert scale. The value of fMRI in providing a prognosis in patients with CHD was assessed. Statistical methods included the T test, Mann-Whitney test, Kappa test, Kaplan-Meier curve, Log-rank test, Cox proportional hazard regression analysis, and receiver operating characteristic curves.
RESULTS
All IQ scores of the short axis CS-cine and both the short and long axes MOCO LGE images were ≥ 3 points. Over a median follow-up of 31 months (range 3.8-38.2), 25 major adverse cardiovascular events (MACE) occurred. In the univariate analysis, infarction size (IS), left ventricular ejection fraction (LVEF), 3D-Global peak longitudinal strain (3D-GPLS), heart failure classification were significantly associated with MACE. When the significantly univariate MACE predictors, added to the multivariate analysis, which showed IS (HR 1.02; 95% CI 1.00-1.05; p = 0.048) and heart failure with preserved EF (HR 0.20; 95% CI 0.04-0.98; p = 0.048) correlated positively with MACE. The optimal cutoff value for LVEF, 3D-GPLS, and IS in predicting MACE was 34.2%, - 5.7%, and 26.1% respectively, with a sensitivity of 90.5%, 64%, and 96.0% and specificity of 72%, 95.2%, and 85.7% respectively.
CONCLUSIONS
The fCMR protocol can be used to make prognostic assessments in patients with CHD and BH limitations by calculating IS and LVEF.
背景与目的
常规心脏磁共振（CCMR）成像通常采用屏气（BH）进行，这在 BH 受限的患者中是不利的。我们探索了自由呼吸心脏磁共振（fCMR）方案在冠心病（CHD）和 BH 能力受限患者中的预后预测能力。
方法
本前瞻性研究纳入了 67 例 CHD 且 BH 能力受限的患者。所有患者均在 3.0T 上进行全面的 fCMR 成像。fCMR 方案包括压缩感知（CS）单次激发电影加速成像和运动校正（MOCO）单次激发晚期钆增强（LGE）成像。根据 5 分李克特量表评估电影和 LGE 图像的图像质量（IQ）。评估 fMRI 在 CHD 患者预后中的价值。统计方法包括 T 检验、Mann-Whitney 检验、Kappa 检验、Kaplan-Meier 曲线、Log-rank 检验、Cox 比例风险回归分析和受试者工作特征曲线。
结果
短轴 CS 电影和短轴及长轴 MOCO LGE 图像的所有 IQ 评分均≥3 分。中位随访 31 个月（范围 3.8-38.2）期间，发生 25 例主要不良心血管事件（MACE）。单因素分析显示，梗死面积（IS）、左心室射血分数（LVEF）、3D 整体纵向应变峰值（3D-GPLS）、心力衰竭分类与 MACE 显著相关。当显著的单因素 MACE 预测因子加入多因素分析时，显示 IS（HR 1.02；95%CI 1.00-1.05；p=0.048）和射血分数保留的心力衰竭（HR 0.20；95%CI 0.04-0.98；p=0.048）与 MACE 呈正相关。预测 MACE 的 LVEF、3D-GPLS 和 IS 的最佳截断值分别为 34.2%、-5.7%和 26.1%，灵敏度分别为 90.5%、64%和 96.0%，特异性分别为 72%、95.2%和 85.7%。
结论
通过计算 IS 和 LVEF，fCMR 方案可用于评估冠心病和 BH 受限患者的预后。
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