Wang Hui, Bo Kairui, Gao Yifeng, Zhou Zhen, Gao Xuelian, Sun Zhonghua, Xu Lei
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, Western Australia, Australia.
Quant Imaging Med Surg. 2024 Jan 3;14(1):888-897. doi: 10.21037/qims-23-466. Epub 2024 Jan 2.
Patients presenting with unexplained T wave inversion on electrocardiogram combined with thickened left ventricular apex but less than 15 mm had been proposed as a preclinical scope of apical hypertrophy cardiomyopathy (pre-ApHCM). However, analysis of left atrial (LA) function in these patients has not been studied. This study aims to evaluate the LA function in pre-ApHCM patients and compare it with patients with ApHCM using cardiac magnetic resonance (CMR) imaging.
In this retrospective case-control study, a total of 3,593 CMR reports from Beijing Anzhen Hospital, Capital Medical University, China were reviewed. Finally, 31 pre-ApHCM patients were identified and 40 ApHCM and 31 normal controls were included for comparison. LA volumetric and strain were analyzed by CMR. Two-tailed one-way ANOVA was used to analyze the difference of three groups. Pearson correlation test was used for correlation analysis.
All of the volumetric parameters in pre-ApHCM group were higher than those in control group. LA reservoir (LA total EF, εs) and conduit function (LA passive EF, εe) parameters, were significantly different among the three groups, which were the lowest in the ApHCM group, intermediate in the pre-ApHCM group, and the highest in the control group ((all P<0.001). Compared with the control group, the LA booster pump function, both the booster EF and booster pump strain (εa) in ApHCM were impaired (P=0.003 and P=0.002 respectively). Meanwhile, only the εa was impaired (P=0.016) while LA booster EF was not (P=0.064) in the pre-ApHCM group, neither εa nor the booster EF show difference between the ApHCM and pre-ApHCM (P=0.272 and P=0.518 respectively).
LA function features in pre-ApHCM patients were similar to ApHCM but different from the normal controls. In pre-ApHCM and ApHCM patients, LA reservoir and conduit function impaired earlier before left atrium enlarged and decreased progressively as apex thickens. These findings may help to understand the LA functional change from pre-ApHCM to ApHCM, and to detect subclinical changes in patients with pre-ApHCM before overt hypertrophy or clinical symptoms develop.
心电图表现为不明原因的T波倒置且左心室心尖增厚但小于15mm的患者被认为处于肥厚型心肌病心尖肥厚的临床前期范围（临床前期心尖肥厚型心肌病，pre-ApHCM）。然而，尚未对这些患者的左心房（LA）功能进行分析。本研究旨在使用心脏磁共振成像（CMR）评估临床前期心尖肥厚型心肌病患者的左心房功能，并与肥厚型心肌病心尖肥厚患者进行比较。
在这项回顾性病例对照研究中，对来自中国首都医科大学附属北京安贞医院的3593份CMR报告进行了回顾。最终，确定了31例临床前期心尖肥厚型心肌病患者，并纳入40例肥厚型心肌病心尖肥厚患者和31例正常对照进行比较。通过CMR分析左心房容积和应变。采用双尾单因素方差分析来分析三组之间的差异。采用Pearson相关检验进行相关性分析。
临床前期心尖肥厚型心肌病组的所有容积参数均高于对照组。左心房储存功能（左心房总射血分数，εs）和管道功能（左心房被动射血分数，εe）参数在三组之间存在显著差异，在肥厚型心肌病心尖肥厚组中最低，在临床前期心尖肥厚型心肌病组中居中，在对照组中最高（均P<0.001）。与对照组相比，肥厚型心肌病心尖肥厚患者的左心房辅助泵功能，即辅助射血分数和辅助泵应变（εa）均受损（分别为P=0.003和P=0.002）。同时，临床前期心尖肥厚型心肌病组仅εa受损（P=0.016），而左心房辅助射血分数未受损（P=0.064），肥厚型心肌病心尖肥厚组与临床前期心尖肥厚型心肌病组之间εa和辅助射血分数均无差异（分别为P=0.272和P=0.518）。
临床前期心尖肥厚型心肌病患者的左心房功能特征与肥厚型心肌病心尖肥厚患者相似，但与正常对照不同。在临床前期心尖肥厚型心肌病和肥厚型心肌病心尖肥厚患者中，左心房储存和管道功能在左心房扩大之前更早受损，并随着心尖增厚而逐渐降低。这些发现可能有助于理解从临床前期心尖肥厚型心肌病到肥厚型心肌病心尖肥厚的左心房功能变化，并在明显肥厚或出现临床症状之前检测临床前期心尖肥厚型心肌病患者的亚临床变化。
