首过法心脏 MRI 中肺通过时间和肺血容量与限制性心肌病舒张功能障碍和左心室变形的关系。
Association of Pulmonary Transit Time and Pulmonary Blood Volume From First-Pass Perfusion Cardiac MRI With Diastolic Dysfunction and Left Ventricle Deformation in Restrictive Cardiomyopathy.
机构信息
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
J Magn Reson Imaging. 2024 Dec;60(6):2343-2355. doi: 10.1002/jmri.29283. Epub 2024 Feb 14.
BACKGROUND
Patients with restrictive cardiomyopathy (RCM) have impaired diastolic filling and hemodynamic congestion. Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) reflect the hemodynamic status, but the relationship with left ventricle (LV) dysfunction remains unclear.
PURPOSE
To evaluate the PTT and PBVi in RCM patients, the association with diastolic dysfunction and LV deformation, and the effects on the occurrence of major adverse cardiac events (MACE) in RCM patients.
STUDY TYPE
Retrospective.
POPULATION
137 RCM patients (88 men, age 58.80 ± 10.83 years) and 68 age- and sex-matched controls (46 men, age 57.00 ± 8.59 years).
FIELD STRENGTH/SEQUENCE: 3.0T/Balanced steady-state free precession sequence, recovery prepared echo-planar imaging sequence, and phase-sensitive inversion recovery sequence.
ASSESSMENT
The LV function and peak strain (PS) parameters were measured. The PTT was calculated and corrected by heart rate (PTTc). The PBVi was calculated as the product of PTTc and RV stroke volume index.
STATISTICAL TESTS
Chi-squared test, student's t-test, Mann-Whitney U test, Pearson's or Spearman's correlation, multivariate linear regression, Kaplan-Meier survival analysis, and Cox regression models analysis. A P-value <0.05 was considered statistically significant.
RESULTS
The PTTc showed a significant correlation with the E/A ratio (r = 0.282), and PBVi showed a significant correlation with the E/e' ratio, E/A ratio, and diastolic dysfunction stage (r = 0.222, 0.320, and 0.270). PTTc showed an independent association with LVEF, LV circumferential PS, and LV longitudinal PS (β = 0.472, 0.299, and 0.328). In Kaplan-Meier analysis, higher PTTc and PBVi were significantly associated with MACE. In multivariable Cox regression analysis, PTTc was a significantly independent predictor of the MACE in combination with both cardiac MRI functional and tissue parameters (hazard ratio: 1.23/1.32, 95% confidence interval: 1.10-1.42/1.20-1.46).
DATA CONCLUSION
PTTc and PBVi are associated with diastolic dysfunction and deteriorated LV deformation, and PTTc independently predicts MACE in patients with RCM.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY: Stage 2.
背景
限制型心肌病（RCM）患者存在舒张期充盈受损和血液动力学淤血。肺通过时间（PTT）和肺血容量指数（PBVi）反映血液动力学状态，但与左心室（LV）功能障碍的关系尚不清楚。
目的
评估 RCM 患者的 PTT 和 PBVi，以及与舒张功能障碍和 LV 变形的关系，并评估其对 RCM 患者发生主要不良心脏事件（MACE）的影响。
研究类型
回顾性研究。
人群
137 例 RCM 患者（88 例男性，年龄 58.80±10.83 岁）和 68 名年龄和性别匹配的对照者（46 例男性，年龄 57.00±8.59 岁）。
磁场强度/序列：3.0T/平衡稳态自由进动序列、恢复准备的回波平面成像序列和相位敏感反转恢复序列。
评估
测量 LV 功能和峰值应变（PS）参数。通过心率校正计算 PTT（PTTc）。将 PTTc 与 RV 每搏量指数相乘得到 PBVi。
统计学检验
卡方检验、学生 t 检验、Mann-Whitney U 检验、Pearson 或 Spearman 相关分析、多元线性回归、Kaplan-Meier 生存分析和 Cox 回归模型分析。P 值<0.05 认为具有统计学意义。
结果
PTTc 与 E/A 比值呈显著相关（r=0.282），PBVi 与 E/e'比值、E/A 比值和舒张功能障碍分期呈显著相关（r=0.222、0.320 和 0.270）。PTTc 与 LVEF、LV 周向 PS 和 LV 纵向 PS 呈独立相关（β=0.472、0.299 和 0.328）。Kaplan-Meier 分析显示，较高的 PTTc 和 PBVi 与 MACE 显著相关。在多变量 Cox 回归分析中，PTTc 与心脏 MRI 功能和组织参数相结合，是 MACE 的显著独立预测因子（危险比：1.23/1.32，95%置信区间：1.10-1.42/1.20-1.46）。
数据结论
PTTc 和 PBVi 与舒张功能障碍和 LV 变形恶化相关，PTTc 独立预测 RCM 患者的 MACE。
证据水平
3 级
技术功效
2 级
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