Zhang Lisha, Wan Yixuan, He Bo, Wang Lei, Zhu Dongyong, Gao Fabao
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Molecular Imaging Center, West China Hospital, Sichuan University, Chengdu, China.
Front Cardiovasc Med. 2022 Oct 4;9:963110. doi: 10.3389/fcvm.2022.963110. eCollection 2022.
This study aims to assess left ventricular (LV) function in hypertrophic cardiomyopathy (HCM) patients with preserved left ventricular ejection fraction (LVEF) by LV strain patterns based on cardiac magnetic resonance feature tracking (CMR-FT) and to explore the relationships between LV strain patterns and cardiac biomarkers in these patients, such as cardiac troponin (cTnT) and N-terminal prohormone of the brain natriuretic peptide (NT-proBNP).
A total of 64 HCM patients with preserved LVEF and 33 healthy people were included in this study. All subjects underwent contrast-enhanced CMR, and all patients took blood tests for cTnT and NT-proBNP during hospitalization.
Despite the absence of a significant difference in LVEF between HCM patients and healthy controls, almost all global and segmental strains in radial, circumferential, and longitudinal directions in the HCM group deteriorated significantly as compared to controls ( < 0.05). Moreover, some global and segmental strains correlated significantly with NT-proBNP and cTnT in HCM patients, and the best correlations were global radial strain (GRS) (r = -0.553, < 0.001) and mid-ventricular radial strain (MRS) (r = -0.582, < 0.001), respectively, with a moderate correlation. The receiver operating characteristic (ROC) results showed that among the LV deformation parameters, GRS [area under the curve (AUC), 0.76; sensitivity, 0.49; specificity, 1.00], MRS (AUC, 0.81; sensitivity, 0.77; specificity, 0.79) demonstrated greater diagnostic accuracy to predict elevated NT-proBNP, and abnormal cTnT, respectively. Their cut-off values were 21.17 and 20.94%, respectively. Finally, all global strains demonstrated moderate, good, and excellent intra- and inter-observer reproducibility.
LV strain patterns can be used to assess the subclinical cardiac function of HCM patients on the merit of being more sensitive than LVEF. In addition, LV strain patterns can detect serious HCM patients and may be helpful to non-invasively predict elevated NT-proBNP and cTnT.
本研究旨在通过基于心脏磁共振特征追踪（CMR-FT）的左室应变模式评估左室射血分数（LVEF）保留的肥厚型心肌病（HCM）患者的左室（LV）功能，并探讨这些患者左室应变模式与心脏生物标志物之间的关系，如心肌肌钙蛋白（cTnT）和脑钠肽前体N末端（NT-proBNP）。
本研究共纳入64例LVEF保留的HCM患者和33名健康人。所有受试者均接受对比增强CMR检查，所有患者在住院期间均进行了cTnT和NT-proBNP的血液检测。
尽管HCM患者与健康对照者的LVEF无显著差异，但与对照组相比，HCM组几乎所有径向、圆周和纵向方向的整体及节段应变均显著恶化（<0.05）。此外，HCM患者的一些整体及节段应变与NT-proBNP和cTnT显著相关，最佳相关性分别为整体径向应变（GRS）（r = -0.553，<0.001）和心室中部径向应变（MRS）（r = -0.582，<0.001），呈中度相关。受试者工作特征（ROC）结果显示，在左室变形参数中，GRS[曲线下面积（AUC），0.76；敏感性，0.49；特异性，1.00]、MRS（AUC，0.81；敏感性，0.77；特异性，0.79）分别对预测NT-proBNP升高和cTnT异常具有更高的诊断准确性。它们的截断值分别为21.17%和20.94%。最后，所有整体应变在观察者内和观察者间均表现出中度、良好和优秀的可重复性。
左室应变模式可用于评估HCM患者的亚临床心脏功能，因其比LVEF更敏感。此外，左室应变模式可检测出严重的HCM患者，可能有助于无创预测NT-proBNP和cTnT升高。
