终末期肾病患儿经组织追踪心脏磁共振成像进行右心室应变分析

Right Ventricular Strain Analysis By Tissue Tracking Cardiac Magnetic Resonance Imaging In Pediatric Patients With End-Stage Renal Disease.

作者信息

Tawfik Ahmed M, Sobh Donia M, Gadelhak Basma, Zedan Mohamed M, Sobh Hoda M, Eid Riham, Hamdy Nashwa, Batouty Nihal M

机构信息

Department of Diagnostic and Interventional Radiology.

Department of Radiology, Andalusia Hospital AlShalalat, Andalusia Group for Medical Services, Alexandria, Egypt.

出版信息

J Thorac Imaging. 2024 Jan 1;39(1):49-56. doi: 10.1097/RTI.0000000000000716. Epub 2023 May 29.

DOI:10.1097/RTI.0000000000000716

PMID:37265246

Abstract

PURPOSE

To investigate right ventricular (RV) volume and mass by cardiac magnetic resonance (CMR) and the added value of tissue tracking strain analysis as markers of RV dysfunction in pediatric patients with end-stage renal disease (ESRD) and preserved RV ejection fraction.

MATERIALS AND METHODS

Twenty-five children with ESRD and preserved RVEF (>50%) and 10 healthy control children were enrolled. Tissue tracking CMR was used to assess Global Longitudinal, circumferential (GCS), and radial short and long axes (GRS SAX and GRS LAX) RV strains in the patients group compared with controls. Correlations between strain parameters and other CMR parameters and clinical biomarkers were assessed. Binary logistic regression was used to test the independence of cofounders and detect their significance.

RESULTS

RV end-diastolic volume and mass (RVMi) were significantly higher in patients (97.2±19.3 mL/m 2 and 26.6±7gr/m 2 ) than control (71±7.8 mL/m 2 and 11.9±2 gr/m 2 , P values 0.000). All RV global strain parameters were significantly impaired in patients compared with control (all P values <0.05). RV Global Longitudinal was significantly correlated to LVEF (r=-0.416, P =0.039), LVEDVi (r=0.481, P =0.015), LVMi (r=0.562, P =0.004), and systolic blood pressure index (r=0.586, P =0.002). RV GRS (LAX) was significantly correlated to LV GCS (r=-0.462, P =0.020) and LV GRS (SAX) (r=0.454, P =0.023). GRS (SAX) and GCS demonstrated the highest diagnostic accuracy (area under curve: 0.82 and 0.81) to detect strain impairment. Univariate binary logistic regression with patients versus control as dependent variables identified LVMi, RV end-diastolic volume, RVMi, weight, body surface area, RV GCS, RV GRS (LAX), RV GRS (SAX), LV GCS, and LV GRS (SAX) as significantly correlated to patients with ESRD. When adjusted to other cofounders in the multivariable model, only RVMi remained as an independent significant cofounder (Odds ratio:0.395, P =0.046).

CONCLUSION

RV global strain, volume, and mass by CMR are markers of RV dysfunction in ESRD pediatric patients with preserved RVEF.

摘要

目的

通过心脏磁共振成像（CMR）研究终末期肾病（ESRD）且右心室射血分数保留的儿科患者的右心室（RV）容积和质量，以及组织追踪应变分析作为RV功能障碍标志物的附加价值。

材料与方法

纳入25例ESRD且右心室射血分数保留（>50%）的儿童及10例健康对照儿童。与对照组相比，采用组织追踪CMR评估患者组RV的整体纵向、圆周（GCS）以及径向短轴和长轴（GRS SAX和GRS LAX）应变。评估应变参数与其他CMR参数及临床生物标志物之间的相关性。采用二元逻辑回归检验混杂因素的独立性并检测其显著性。

结果

患者的RV舒张末期容积和质量（RVMi）显著高于对照组（分别为97.2±19.3 mL/m²和26.6±7gr/m²），而对照组为（71±7.8 mL/m²和11.9±2 gr/m²，P值均为0.000）。与对照组相比，患者的所有RV整体应变参数均显著受损（所有P值<0.05）。RV整体纵向应变与左心室射血分数（r=-0.416，P =0.039）、左心室舒张末期容积指数（r=0.481，P =0.015）、左心室质量指数（r=0.562，P =0.004）以及收缩压指数（r=0.586，P =0.002）显著相关。RV GRS（LAX）与左心室GCS（r=-0.462，P =0.020）和左心室GRS（SAX）（r=0.454，P =0.023）显著相关。GRS（SAX）和GCS在检测应变受损方面显示出最高的诊断准确性（曲线下面积：0.82和0.81）。以患者与对照为因变量的单变量二元逻辑回归确定左心室质量指数、RV舒张末期容积、RVMi、体重、体表面积、RV GCS、RV GRS（LAX）、RV GRS（SAX）、左心室GCS和左心室GRS（SAX）与ESRD患者显著相关。在多变量模型中对其他混杂因素进行校正后，仅RVMi仍为独立的显著混杂因素（比值比：0.395，P =0.046）。