Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy.
U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
Int J Cardiovasc Imaging. 2023 May;39(5):991-999. doi: 10.1007/s10554-023-02792-3. Epub 2023 Jan 13.
The left ventricular global function index (LVGFI) is a comprehensive marker of cardiac performance, integrating LV morphology with global function. We explored the cross-sectional association of LVGFI with myocardial iron overload (MIO), LV ejection fraction (LVEF), myocardial fibrosis, and heart failure (HF) in β-thalassemia major (TM) patients.
We considered 1352 adult TM patients (708 females, 32.79 ± 7.16years) enrolled in the Myocardial Iron Overload in Thalassemia Network and 112 healthy subjects (50 females, 32.09 ± 6.08years). LVGFI and LVEF were assessed by cine images and MIO by multislice multiecho T2* technique. Replacement myocardial fibrosis was detected by late gadolinium enhancement technique.
LVGFI and LVEF were significantly lower in patients with significant MIO (global heart T2*<20ms) than in patients without MIO and in healthy subjects but were comparable between TM patients without MIO and healthy subjects. In TM, LVGFI was significantly associated with LVEF (R = 0.733; p < 0.0001). Global heart T2* values were significantly associated with both LVGFI and LVEF, but the correlation with LVGFI was significantly stronger (p = 0.0001). Male sex, diabetes mellitus, significant MIO, and replacement myocardial fibrosis were the strongest predictors of LVGFI. Eighty-six patients had a history of HF and showed significantly lower global heart T2* values, LVEF, and LVGFI than HF-free patients. A LVGFI ≤ 44.9% predicted the presence of HF. The LVGFI showed a diagnostic performance superior to that of LVEF (area under the curve: 0.67 vs. 0.62; p = 0.039).
In TM patients the LVGFI correlates with MIO and provides incremental diagnostic value for HF detection compared with LVEF.
左心室整体功能指数（LVGFI）是心脏功能的综合标志物，综合了左心室形态和整体功能。我们探讨了 LVGFI 与β地中海贫血（TM）患者心肌铁过载（MIO）、左心室射血分数（LVEF）、心肌纤维化和心力衰竭（HF）的横断面相关性。
我们纳入了 1352 名成年 TM 患者（708 名女性，32.79±7.16 岁）和 112 名健康对照者（50 名女性，32.09±6.08 岁），他们都参与了地中海贫血铁过载网络研究。使用电影图像评估 LVGFI 和 LVEF，使用多回波多层 T2*技术评估 MIO。使用钆延迟增强技术检测替代心肌纤维化。
与无 MIO 的 TM 患者和健康对照者相比，有明显 MIO（全心脏 T2*<20ms）的患者的 LVGFI 和 LVEF 显著降低，但无 MIO 的 TM 患者与健康对照者的 LVGFI 和 LVEF 无差异。在 TM 患者中，LVGFI 与 LVEF 显著相关（R=0.733；p<0.0001）。全心脏 T2值与 LVGFI 和 LVEF 均显著相关，但与 LVGFI 的相关性更强（p=0.0001）。男性、糖尿病、明显的 MIO 和替代心肌纤维化是 LVGFI 的最强预测因子。86 名患者有 HF 病史，他们的全心脏 T2值、LVEF 和 LVGFI 显著低于无 HF 病史的患者。LVGFI≤44.9%预测 HF 的存在。LVGFI 的诊断性能优于 LVEF（曲线下面积：0.67 比 0.62；p=0.039）。
在 TM 患者中，LVGFI 与 MIO 相关，与 LVEF 相比，对 HF 的检测具有额外的诊断价值。
