源自心脏磁共振成像的左心室应变能够预测法洛四联症修补术后患者肺动脉瓣置换的预后。
Left ventricular strain derived from cardiac magnetic resonance can predict outcomes of pulmonary valve replacement in patients with repaired tetralogy of Fallot.
作者信息
Zhuang Baiyan, Yu Shiqin, Feng Zicong, He Fengpu, Jiang Yong, Zhao Shihua, Lu Minjie, Li Shoujun
机构信息
Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Aug 18;9:917026. doi: 10.3389/fcvm.2022.917026. eCollection 2022.
PURPOSE
Several adults with repaired tetralogy of Fallot (rToF) undergo pulmonary valve replacement (PVR) to reduce the right ventricular volume and retain right ventricular function. However, there is currently no consensus on the ideal time for PVR surgery in asymptomatic patients with rTOF with pulmonary regurgitation (PR). Clinical outcomes after PVR are also indeterminate. Recently, myocardial strain and strain rate derived from cardiac magnetic resonance (CMR) feature tracking were found to be more sensitive to right ventricular dysfunction than conventional parameters and therefore may add prognostic value in patients with rToF. We aimed to analyze whether pre-PVR left ventricular (LV) strain and strain rate detected by CMR feature tracking are associated with midterm outcomes after PVR in patients with rToF.
METHODS
Seventy-eight asymptomatic patients with rToF who required PVR due to moderate or severe PR were prospectively enrolled between January 2014 and June 2020. CMR cine sequences were obtained, and feature tracking parameters were measured preoperatively. Adverse events were documented during the follow-up. Receiver operating characteristic analysis was performed to determine the cutoff value. Kaplan-Meier curves were drawn with log-rank statistics; moreover, univariate and multivariate Cox proportional hazards regression analyses and Harrel C-indices were analyzed.
RESULTS
During 3.6 ± 1.8 years of follow-up, 25 adverse events were recorded. Kaplan-Meier survival curves and univariate Cox analysis verified that patients with significantly reduced radial strain (RS), circumferential strain (CS), longitudinal strain (LS), RS rate at systole and diastole (RSRs and RSRe), and circumferential and LS rates at diastole (CSRe and LSRe) had worse event-free survival. After multivariate correction, only LS and LSRe remained significantly associated with adverse outcomes (hazard ratio = 1.243 [1.083-1.428] and 0.067 [0.017-0.258], respectively, all < 0.05). The cutoff values of LS and LSRe were -12.30 (%) and 1.07 (s), respectively.
CONCLUSION
The LV strain and strain rate prior to PVR are important prognostic factors for adverse events after PVR in rToF.
目的
数名法洛四联症修复术后（rToF）的成人接受肺动脉瓣置换术（PVR）以减少右心室容量并保留右心室功能。然而，目前对于无症状的rTOF合并肺动脉反流（PR）患者进行PVR手术的理想时机尚无共识。PVR后的临床结果也不确定。最近，发现源自心脏磁共振（CMR）特征追踪的心肌应变和应变率比传统参数对右心室功能障碍更敏感，因此可能对rToF患者具有预后价值。我们旨在分析CMR特征追踪检测到的PVR前左心室（LV）应变和应变率是否与rToF患者PVR后的中期结果相关。
方法
2014年1月至2020年6月期间前瞻性纳入了78名因中度或重度PR而需要PVR的无症状rToF患者。获取CMR电影序列，并在术前测量特征追踪参数。随访期间记录不良事件。进行受试者工作特征分析以确定临界值。绘制Kaplan-Meier曲线并进行对数秩统计；此外，分析单因素和多因素Cox比例风险回归分析以及Harrel C指数。
结果
在3.6±1.8年的随访期间，记录了25起不良事件。Kaplan-Meier生存曲线和单因素Cox分析证实，径向应变（RS）、圆周应变（CS）、纵向应变（LS）、收缩期和舒张期RS率（RSRs和RSRe）以及舒张期圆周和LS率（CSRe和LSRe）显著降低的患者无事件生存期较差。多因素校正后，只有LS和LSRe仍与不良结局显著相关（风险比分别为1.243 [1.083 - 1.428]和0.067 [0.017 - 0.258]，均<0.05）。LS和LSRe的临界值分别为-12.30（%）和1.07（s）。
结论
PVR前LV应变和应变率是rToF患者PVR后不良事件的重要预后因素。
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