Song Linsheng, Zhao Xinyi, Lv Wenlong, Zeng Jie, Wang Yishuang, Gong Bo, Kalogeropoulos Andreas P, Pu Hong, Bai Yifeng, Peng Shengkun
Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Ann Transl Med. 2022 Feb;10(4):215. doi: 10.21037/atm-22-660.
Patients with nonischemic dilated cardiomyopathy (NIDCM) and malignant ventricular arrhythmia (MVA) often have a poor prognosis and a high risk of sudden cardiac death. Although the diagnosis of MVA is straightforward by electrocardiogram (ECG), the underlying abnormalities of ventricular mechanics in these patients are unknown. This study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy.
In this retrospective study, patients with NIDCM who met inclusion criteria were divided into an MVA group and a non-MVA group (included from January 2018 to September 2021). The interobserver agreement of myocardial strain parameters, including global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), were tested. The GLS, GCS, GRS, left ventricular ejection fraction (LVEF), T-T interval on ECG and brain natriuretic peptide (BNP) were compared between groups. Single-factor and multifactor receiver operating characteristic (ROC) curve analyses were conducted to calculate the area under the ROC curve (AUC), cut-off point, sensitivity, and specificity of these parameters in predicting MVA in NIDCM.
A total of 161 NIDCM patients were included (54 in the MVA group). GLS, GCS, and GRS had good interobserver agreement (all intraclass correlation coefficients >0.80). The absolute GLS and GCS, GRS and LVEF were lower in the MVA group than the non-MVA group (P<0.001), T-T and BNP were higher (P<0.001). Single-factor ROC curve analysis showed that GLS, GCS and GRS had certain diagnostic value for MVA (AUC =0.795, 0.802, and 0.754, respectively). Among them, GCS had higher sensitivity and specificity (GCS 0.796/0.776, GLS 0.778/0.757, GRS 0.741/0.692). Multifactor ROC curve analysis showed the combination of GLS and GCS (AUC =0.810), the combination of GCS and GRS (AUC =0.802), the combination of GLS and GRS (AUC =0.787), the combination of GLS, GCS, and GRS (AUC =0.810).
The three-dimensional myocardial strain parameters (especially GLS and GCS) measured by CMR-FT had certain diagnostic value and could reflect the underlying abnormality of ventricular mechanics of NIDCM with MVA.
非缺血性扩张型心肌病（NIDCM）合并恶性室性心律失常（MVA）的患者预后通常较差，心脏性猝死风险较高。虽然通过心电图（ECG）诊断MVA很直接，但这些患者心室力学的潜在异常尚不清楚。本研究旨在初步探讨心脏磁共振特征追踪（CMR-FT）对扩张型心肌病中MVA的评估价值。
在这项回顾性研究中，将符合纳入标准的NIDCM患者分为MVA组和非MVA组（纳入时间为2018年1月至2021年9月）。对包括整体纵向应变（GLS）、整体圆周应变（GCS）和整体径向应变（GRS）在内的心肌应变参数进行观察者间一致性检验。比较两组之间的GLS、GCS、GRS、左心室射血分数（LVEF）、心电图上的T波间期和脑钠肽（BNP）。进行单因素和多因素受试者工作特征（ROC）曲线分析，以计算这些参数预测NIDCM中MVA的ROC曲线下面积（AUC）、切点、敏感性和特异性。
共纳入161例NIDCM患者（MVA组54例）。GLS、GCS和GRS具有良好的观察者间一致性（所有组内相关系数>0.80）。MVA组的绝对GLS、GCS、GRS和LVEF低于非MVA组（P<0.001），T波间期和BNP则更高（P<0.001）。单因素ROC曲线分析显示，GLS、GCS和GRS对MVA具有一定的诊断价值（AUC分别为0.795、0.802和0.754）。其中，GCS具有更高的敏感性和特异性（GCS为0.796/0.776，GLS为0.778/0.757，GRS为0.741/0.692）。多因素ROC曲线分析显示，GLS和GCS联合（AUC =0.810）、GCS和GRS联合（AUC =0.802）、GLS和GRS联合（AUC =0.787）、GLS、GCS和GRS联合（AUC =0.810）。
CMR-FT测量的三维心肌应变参数（尤其是GLS和GCS）具有一定的诊断价值，能够反映合并MVA的NIDCM患者心室力学的潜在异常。
