Liu Shengliang, Li Yunling, Zhao Yanming, Wang Xueying, Wu Zhiyuan, Gu Xia, Xu Bing, Li Ye, Tian Jinwei, Cui Jinjin, Wang Guokun, Yu Bo
Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.
Front Cardiovasc Med. 2022 May 11;9:865615. doi: 10.3389/fcvm.2022.865615. eCollection 2022.
The differentiation between hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) is challenging due to similar myocardial hypertrophic phenotype. The purpose of this study is to evaluate the feasibility of cardiovascular magnetic resonance feature tracking (CMR-FT) and late gadolinium enhancement (LGE) to distinguish between HCM and HHD and the potential relationship between myocardial strain and cardiac functional parameters.
One hundred and seventy subjects (57 HCM, 45 HHD, and 68 controls) underwent 3.0 T CMR, including steady-state free precession cines and LGE images. Global and segmental (basal, mid, and apical) analyses of myocardial radial, circumferential, longitudinal strain, and left ventricular (LV) torsion, as well as global and 16 segments of LGE were assessed. The multivariate analysis was used to predict the diagnostic ability by combining comprehensive myocardial strain parameters and LGE.
Global radial strain (GRS), global circumferential strain (GCS), and LV torsion were significantly higher in the HCM group than in the HHD group (GRS, 21.18 ± 7.52 vs. 14.56 ± 7.46%; GCS, -13.34 ± 3.52 vs. -10.11 ± 4.13%; torsion, 1.79 ± 0.69 vs. 1.23 ± 0.65 deg/cm, all < 0.001). A similar trend was also seen in the corresponding strain rate. As for segmental strain analysis, basal radial strain (BRS), basal circumferential strain (BCS), basal longitudinal strain (BLS), mid-radial strain (MRS), and mid-circumferential strain (MCS) were higher in the HCM group than in the HHD group (all < 0.001). The receiver operating characteristic (ROC) results showed that the area under the curve (AUC) of LGE in the mid-interventricular septum (mIVS) was the highest among global and segmental LGE analyses. On the multivariate regression analysis, a combined model of LGE (mIVS) with GRS obtained the highest AUC value, which was 0.835 with 88.89% sensitivity and 70.18% specificity, respectively. In addition, for patients with HCM, GRS, GCS, and global longitudinal strain had correlations with LV ejection fraction (LVEF), maximum interventricular septum thickness (IVST max), and left ventricular mass index (LVMi). Torsion was mildly associated with LVEF.
CMR-FT-derived myocardial strain and torsion provided valuable methods for evaluation of HCM and HHD. In addition, the combination of GRS and LGE (mIVS) achieved the highest diagnostic value.
肥厚型心肌病（HCM）和高血压性心脏病（HHD）由于心肌肥厚表型相似，鉴别具有挑战性。本研究旨在评估心血管磁共振特征追踪（CMR-FT）和延迟钆增强（LGE）区分HCM和HHD的可行性以及心肌应变与心功能参数之间的潜在关系。
170名受试者（57例HCM、45例HHD和68例对照）接受3.0T CMR检查，包括稳态自由进动电影成像和LGE图像。对心肌径向、圆周、纵向应变以及左心室（LV）扭转进行整体和节段性（基底、中间和心尖）分析，并评估LGE的整体和16个节段情况。采用多变量分析通过综合心肌应变参数和LGE预测诊断能力。
HCM组的整体径向应变（GRS）、整体圆周应变（GCS）和LV扭转显著高于HHD组（GRS：21.18±7.52%对14.56±7.46%；GCS：-13.34±3.52%对-10.11±4.13%；扭转：1.79±0.69°/cm对1.23±0.65°/cm，均P<0.001）。相应应变率也呈现类似趋势。至于节段应变分析方面，HCM组的基底径向应变（BRS）、基底圆周应变（BCS）、基底纵向应变（BLS）、中间径向应变（MRS）和中间圆周应变（MCS）高于HHD组（均P<0.001）。受试者操作特征（ROC）结果显示，在整体和节段性LGE分析中，室间隔中部（mIVS）的LGE曲线下面积（AUC）最高。多变量回归分析显示，LGE（mIVS）与GRS的联合模型获得最高AUC值，分别为0.835，敏感性为88.89%，特异性为70.18%。此外，对于HCM患者，GRS、GCS和整体纵向应变与LV射血分数（LVEF）、最大室间隔厚度（IVST max）和左心室质量指数（LVMi）相关。扭转与LVEF轻度相关。
CMR-FT得出的心肌应变和扭转可为评估HCM和HHD提供有价值的方法。此外，GRS和LGE（mIVS）的联合诊断价值最高。
