Sun Wei, Shen Xuehua, Wang Jing, Zhu Shuangshuang, Zhang Yanting, Wu Chun, Xie Yuji, Yang Yun, Dong Nianguo, Wang Guohua, Li Yuman, Lv Qing, Liang Bo, Zhang Li, Xie Mingxing
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.
Front Cardiovasc Med. 2021 Nov 30;8:727745. doi: 10.3389/fcvm.2021.727745. eCollection 2021.
This study aimed to: (1) evaluate the association between myocardial fibrosis (MF) quantified by extracellular volume fraction (ECV) and myocardial strain measured by two-dimensional (2D)- and three-dimensional speckle-tracking echocardiography (3D-STE) and (2) further investigate which strain parameter measured by 2D- and 3D-STE is the more robust predictor of MF in heart transplant (HT) recipients. A total of 40 patients with HT and 20 healthy controls were prospectively enrolled. Left ventricular (LV)-global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured by 2D- and 3D-STE. LV diffuse MF was defined by cardiovascular magnetic resonance (CMR)-ECV. The HT recipients had a significantly higher native T1 and ECV than healthy controls (1043.8 ± 34.0 vs. 999.7 ± 19.7 ms, < 0.001; 26.6 ± 2.7 vs. 24.3 ± 1.8%, = 0.02). The 3D- and 2D-STE-LVGLS and LVGCS were lower ( < 0.005) in the HT recipients than in healthy controls. ECV showed a moderate correlation with 2D-LVGLS ( = 0.53, = 0.002) and 3D-LVGLS ( = 0.60, < 0.001), but it was not correlated with 2D or 3D-LVGCS, or LVGRS. Furthermore, 3D-LVGLS and 2D-LVGLS had a similar correlation with CMR-ECV ( = 0.60 vs. 0.53, = 0.670). A separate stepwise multivariate linear analysis showed that both the 2D-LVGLS (β = 0.39, = 0.019) and 3D-LVGLS (β = 0.54, < 0.001) were independently associated with CMR-ECV. CMR marker of diffuse MF was present in asymptomatic patients with HT and appeared to be associated with decreased myocardial strain by echocardiography. Both the 2D- and 3D-LVGLS were independently correlated with diffuse LVMF, which may provide an alternative non-invasive tool for monitoring the development of adverse fibrotic remodeling during the follow-up of HT recipients.
（1）评估通过细胞外容积分数（ECV）量化的心肌纤维化（MF）与通过二维（2D）和三维斑点追踪超声心动图（3D-STE）测量的心肌应变之间的关联，以及（2）进一步研究2D和3D-STE测量的哪种应变参数是心脏移植（HT）受者MF的更可靠预测指标。前瞻性纳入了40例HT患者和20名健康对照者。通过2D和3D-STE测量左心室（LV）整体纵向应变（GLS）、整体圆周应变（GCS）和整体径向应变（GRS）。LV弥漫性MF由心血管磁共振（CMR）-ECV定义。HT受者的固有T1和ECV显著高于健康对照者（1043.8±34.0对999.7±19.7毫秒，<0.001；26.6±2.7对24.3±1.8%，=0.02）。HT受者的3D和2D-STE-LVGLS及LVGCS低于健康对照者（<0.005）。ECV与2D-LVGLS（=0.53，=0.002）和3D-LVGLS（=0.60，<0.001）呈中度相关，但与2D或3D-LVGCS及LVGRS无相关性。此外，3D-LVGLS和2D-LVGLS与CMR-ECV的相关性相似（=0.60对0.53，=0.670）。一项单独的逐步多元线性分析显示，2D-LVGLS（β=0.39，=0.019）和3D-LVGLS（β=0.54，<0.001）均与CMR-ECV独立相关。弥漫性MF的CMR标志物在无症状HT患者中存在，且似乎与超声心动图显示的心肌应变降低有关。2D和3D-LVGLS均与弥漫性LV MF独立相关，这可能为HT受者随访期间监测不良纤维化重塑的发展提供一种替代性非侵入性工具。
