She Jiaqi, Zhao Shihai, Chen Yinyin, Zeng Mengsu, Jin Hang
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China.
Acad Radiol. 2023 Feb;30(2):230-238. doi: 10.1016/j.acra.2022.03.022. Epub 2022 Apr 24.
The value of myocardial strain for reflecting fibrosis in patients with hypertrophic cardiomyopathy (HCM) on cardiac magnetic resonance (CMR) has not been definite. We aim to explore whether there are underlying non-contrast parameters to evaluate myocardial fibrosis and screen which may be the best.
We retrospectively included 127 HCM patients (89 men; average age 46.6 ± 15.6 years) and 30 healthy controls (20 men; average age 52.0 ± 13.2 years) who have undergone late gadolinium enhancement (LGE) CMR. Next, 127 HCM patients were divided randomly into two sets including training cohort and validation cohort. Strain and imaging parameters were measured and analyzed statistically.
Based on univariate and multivariate analysis, segmental circumferential strain (SCS) (p < 0.001) and maximal wall thickness (MWT) (p < 0.001) may differentiate myocardial segments with or without LGE as significant biomarkers for both sets. The area under the curve (AUC) was 0.803 (95% CI 0.785-0.820) for SCS and 0.777 (95% CI 0.759-0.795) for MWT to identify myocardial fibrosis. When combining SCS >-13.9% and MWT >16.4mm, the specificity of the model (AUC = 0.779; 95% CI 0.760-0.796) achieved the highest 93.9%, with a sensitivity of 61.8%.
Strain analysis in HCM holds promise for myocardial fibrosis detection and SCS is the best strain parameter based on CMR. Nevertheless, the model of combining SCS and MWT could achieve the highest specificity for fibrotic diagnosis.
心肌应变在心脏磁共振成像（CMR）中反映肥厚型心肌病（HCM）患者心肌纤维化的价值尚未明确。我们旨在探索是否存在潜在的非对比参数来评估心肌纤维化，并筛选出可能最佳的参数。
我们回顾性纳入了127例接受延迟钆增强（LGE）CMR检查的HCM患者（89例男性；平均年龄46.6±15.6岁）和30例健康对照者（20例男性；平均年龄52.0±13.2岁）。接下来，将127例HCM患者随机分为两组，即训练队列和验证队列。测量应变和成像参数并进行统计学分析。
基于单因素和多因素分析，节段圆周应变（SCS）（p<0.001）和最大壁厚（MWT）（p<0.001）可作为两组中区分有无LGE心肌节段的重要生物标志物。SCS识别心肌纤维化的曲线下面积（AUC）为0.803（95%CI 0.785 - 0.820），MWT为0.777（95%CI 0.759 - 0.795）。当联合SCS>-13.9%和MWT>16.4mm时，模型的特异性（AUC = 0.779；95%CI 0.760 - 0.796）达到最高的93.9%，敏感性为61.8%。
HCM中的应变分析在心肌纤维化检测方面具有前景，基于CMR，SCS是最佳的应变参数。然而，联合SCS和MWT的模型在纤维化诊断中可实现最高的特异性。
