Zheng Y, Liu X, Yang K, Chen X, Wang J, Zhao K, Dong W, Yin G, Yu S, Yang S, Lu M, Su G, Zhao S
Department of Radiology, Tsinghua University Hospital, Tsinghua University, Beijing, 100084, China; Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China.
Department of Neurology, Beijing Geriatric Hospital, Wenquan Road No 118, Haidian District, Beijing 100095, China.
Clin Radiol. 2024 May;79(5):e692-e701. doi: 10.1016/j.crad.2023.12.027. Epub 2024 Jan 20.
To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT).
One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters.
Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients.
LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.
描述心脏淀粉样变性（CA）患者的心肌扭转力学，并使用心脏磁共振成像特征追踪（CMR-FT）评估左心室（LV）扭转力学与传统参数之间的相关性。
139例轻链型CA（AL-CA）患者分为三组：1组收缩功能保留（左心室射血分数[LVEF]≥50%，n = 55），2组收缩功能轻度降低（40%≤LVEF<50%，n = 51），3组收缩功能降低（LVEF<40%，n = 33），并与年龄和性别匹配的健康对照者（n = 26）进行比较。所有患者均接受电影成像和延迟钆增强（LGE）检查。使用CMR-FT对电影图像进行离线分析以估计扭转参数。
收缩功能保留的患者整体扭转、心底-心中部扭转和舒张末期峰值扭转率（diasTR）显著受损（均p<0.05），而与健康对照者相比，心尖中部扭转和收缩期峰值扭转率（sysTR）保留（均p>0.05）。收缩功能轻度降低的患者，与收缩功能保留的患者相比，整体扭转和心底-心中部扭转较低（均p<0.05），而心尖中部扭转、sysTR和diasTR保留（均p>0.05）。收缩功能降低的患者，与收缩功能轻度降低的患者相比，仅sysTR显著更差（p<0.05）。在多变量分析中，右心室（RV）收缩末期容积RVESV指数和纽约心脏协会（NYHA）分级与整体扭转独立相关，而LVEF与sysTR独立相关。右心室射血分数（RVEF）与diasTR独立相关。在区分AL-CA患者透壁性与非透壁性LGE方面，LV整体扭转表现良好（曲线下面积[AUC]0.71；95%置信区间[CI]：0.61，0.77）。
CMR-FT得出的LV扭转力学有助于监测AL-CA患者的LV收缩和舒张功能，并可作为LV功能障碍和LGE透壁性的新成像标志物。
