Benjamin Mina M, Arora Punit, Munir Muhammad S, Darki Amir, Liebo Max, Yu Mingxi, Syed Mushabbar A, Kinno Menhel
Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, Illinois.
Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
J Magn Reson Imaging. 2023 Apr;57(4):1275-1284. doi: 10.1002/jmri.28320. Epub 2022 Jul 8.
Left atrial (LA) function and strain patterns by magnetic resonance imaging (MRI) have been investigated as markers of several cardiovascular pathologies, including cardiac amyloidosis (CA). However, associations with clinical outcomes have not been investigated.
To compare LA function and strain by MRI in CA patients to a matched cohort of patients without cardiovascular disease (CVD) and evaluate the association with long-term clinical outcomes in CA patients.
Retrospective case control.
A total of 51 patients with CA and 51 age-, gender-, and race-matched controls without CVD who underwent MRI in sinus rhythm.
FIELD STRENGTH/SEQUENCE: ECG-gated balanced steady-state free precession sequence at 1.5 T.
All measurements were completed by one investigator (M.M.B.). LA function and strain parameters were measured including LA indexed minimum and maximum volumes, LA reservoir (R), contractile (CT), and conduit (CD) strain. We compared groups after adjusting for age, hypertension, New York Heart Association class, modified staging system (troponin-I, BNP, estimated GFR) and left ventricular ejection fraction (LVEF) for an endpoint of all-cause mortality and a composite endpoint of heart failure hospitalization (HFH) or death.
Differences between groups were evaluated with t tests for continuous variables or χ tests for categorical variables. A multivariable regression model was used to assess the associations of the P values-two-sided tests-<0.05 were considered statistically significant.
CA patients with median follow up of 4.9 (8.5) months had significantly lower LA strain and higher LA volumes in comparison to the matched cohort. In the multivariable analysis, only LVEF was significantly associated with death while ƐCT (OR 0.6, CI: 0.41-0.89), indexed minimum LA volume (OR 1.06, CI: 1.02-1.13) and indexed maximum LA volume (OR 1.08, CI: 1.01-1.15) were significantly associated with the composite outcome of death or HFH.
In this retrospective study of CA patients, ƐCT and indexed minimum and maximum LA volumes were significantly associated with the composite outcome of death or HFH.
3 TECHNICAL EFFICACY: Stage 3.
磁共振成像（MRI）检测的左心房（LA）功能和应变模式已被作为包括心脏淀粉样变性（CA）在内的多种心血管疾病的标志物进行研究。然而，尚未对其与临床结局的相关性进行研究。
通过MRI比较CA患者与匹配的无心血管疾病（CVD）患者队列的LA功能和应变，并评估其与CA患者长期临床结局的相关性。
回顾性病例对照研究。
共有51例CA患者和51例年龄、性别和种族匹配的无CVD且窦性心律下接受MRI检查的对照者。
场强/序列：1.5T下的心电图门控平衡稳态自由进动序列。
所有测量均由一名研究者（M.M.B.）完成。测量LA功能和应变参数，包括LA指数化最小和最大容积、LA储存（R）、收缩（CT）和管道（CD）应变。在调整年龄、高血压、纽约心脏协会分级、改良分期系统（肌钙蛋白I、脑钠肽、估算的肾小球滤过率）和左心室射血分数（LVEF）后，我们比较了两组患者的全因死亡率终点以及心力衰竭住院（HFH）或死亡的复合终点。
采用t检验评估连续变量组间差异，采用χ检验评估分类变量组间差异。使用多变量回归模型评估P值的相关性——双侧检验——P<0.05被认为具有统计学意义。
与匹配队列相比，中位随访4.9（8.5）个月的CA患者LA应变显著降低，LA容积更高。在多变量分析中，只有LVEF与死亡显著相关，而ƐCT（比值比0.6，置信区间：0.41 - 0.89）、指数化最小LA容积（比值比1.06，置信区间：1.02 - 1.13）和指数化最大LA容积（比值比1.08，置信区间：1.01 - 1.15）与死亡或HFH的复合结局显著相关。
在这项对CA患者的回顾性研究中，ƐCT以及指数化最小和最大LA容积与死亡或HFH的复合结局显著相关。
3 技术效能：3级
