MRI 评估系统性硬化症患者左、右心室舒张功能。

Diastolic Function Assessment of Left and Right Ventricles by MRI in Systemic Sclerosis Patients.

机构信息

Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.

Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France.

出版信息

J Magn Reson Imaging. 2022 Nov;56(5):1416-1426. doi: 10.1002/jmri.28143. Epub 2022 Mar 8.

DOI:10.1002/jmri.28143

PMID:35258133

Abstract

BACKGROUND

Heart involvement is frequent although often clinically silent in systemic sclerosis (SSc) patients. Early identification of cardiac involvement can be improved by noninvasive methods such as MRI, in addition to transthoracic echocardiography (TTE).

PURPOSE

To assess the ability of phase-contrast (PC)-MRI to detect subclinical left (LV) and right (RV) ventricular diastolic dysfunction in SSc patients.

STUDY TYPE

Prospective.

POPULATION

Thirty-five consecutive SSc patients (49 ± 14 years) and 35 sex- and age-matched healthy controls (48.6 ± 13.5 years) who underwent TTE and MRI in the same week.

FIELD STRENGTH/SEQUENCE: 5 T/PC-MRI using a breath-hold velocity-encoded gradient echo sequence.

ASSESSMENT

LV TTE (E/E') and LV and RV PC-MRI indices of diastolic function (LV early and late transmitral [E , Ef , A , Af ] and RV transtricuspid [E , Ef , A , Af ] peak filling flow velocities and flow rates, as well as LV [ ] and RV [ ] peak longitudinal myocardial velocities during diastole) were measured.

STATISTICAL TESTS

Two-tailed t-test, Wilcoxon test, or Fischer test for comparison of variables between SSc and healthy control groups; sensitivity, specificity, receiver-operating-characteristic (ROC) area under the curve (AUC) to assess discriminative ability of variables. A P-value <0.05 was considered statistically significant.

RESULTS

TTE LV E/E' and MRI E / and E / were significantly higher in SSc patients than in controls (8.27 ± 1.25 vs. 6.70 ± 1.66; 9.43 ± 2.7 vs. 6.51 ± 1.50; 6.51 [4.70-10.40] vs. 4.13 [3.22-5.75], respectively) and separated SSc patients and healthy controls with good sensitivity (68%, 71%, and 80%), specificity (85%, 94%, and 62%), and AUC (0.787, 0.807, and 0.765). LV Ef was significantly higher in SSc patients than in controls (347.1 ± 113.7 vs. 284.7 ± 94.6) as RVAf (277 [231-355] vs. 220 [154-253] mL/sec) with impaired relaxation pattern (Ef /Af , 0.95 [0.87-1.21] vs. 1.12 [0.93-1.47]).

DATA CONCLUSION

MRI was able to detect LV and RV diastolic dysfunction in SSc patients with good accuracy in the absence of LV systolic dysfunction at echocardiography. Use of MRI can allow to better assess the early impact of myocardial fibrosis related to SSc.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 2.

摘要

背景

系统性硬化症（SSc）患者常存在心脏受累，尽管通常无临床症状。除经胸超声心动图（TTE）外，磁共振成像（MRI）等非侵入性方法也可提高心脏受累的早期识别能力。

目的

评估相位对比（PC）-MRI 检测 SSc 患者亚临床左心室（LV）和右心室（RV）舒张功能障碍的能力。

研究类型

前瞻性。

人群

35 例连续 SSc 患者（49±14 岁）和 35 名性别和年龄匹配的健康对照者（48.6±13.5 岁），他们在同一周内接受了 TTE 和 MRI。

磁场强度/序列：使用 5T/PC-MRI 进行屏气速度编码梯度回波序列。

评估

LV TTE（E/E'）和 LV 和 RV PC-MRI 舒张功能指数（LV 早期和晚期二尖瓣[E、Ef、A、Af]和 RV 三尖瓣[E、Ef、A、Af]峰值充盈流速和流量，以及 LV[ ]和 RV[ ]舒张期峰值纵向心肌速度）。

统计学检验

比较 SSc 组和健康对照组之间变量的双尾 t 检验、Wilcoxon 检验或 Fischer 检验；评估变量的判别能力的敏感性、特异性、受试者工作特征（ROC）曲线下面积（AUC）。P 值<0.05 被认为具有统计学意义。

结果

与健康对照组相比，SSc 患者的 TTE LV E/E'和 MRI E/ 和 E/ 明显更高（8.27±1.25 比 6.70±1.66；9.43±2.7 比 6.51±1.50；6.51[4.70-10.40]比 4.13[3.22-5.75]），并具有良好的敏感性（68%、71%和 80%）、特异性（85%、94%和 62%）和 AUC（0.787、0.807 和 0.765）来区分 SSc 患者和健康对照者。SSc 患者的 LV Ef 明显高于健康对照组（347.1±113.7 比 284.7±94.6），而 RVAf（277[231-355]比 220[154-253]mL/sec）呈松弛不良模式（Ef/Af，0.95[0.87-1.21]比 1.12[0.93-1.47]）。