左心房及左心耳血流动力学与无症状性脑梗死相关性的磁共振成像研究

MRI Investigation of the Association of Left Atrial and Left Atrial Appendage Hemodynamics with Silent Brain Infarction.

作者信息

Pradella Maurice, Baraboo Justin J, Prabhakaran Shyam, Zhao Lihui, Hijaz Tarek, McComb Erin N, Naidich Michelle J, Heckbert Susan R, Nasrallah Ilya M, Bryan R Nick, Passman Rod S, Markl Michael, Greenland Philip

机构信息

Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.

出版信息

J Magn Reson Imaging. 2025 Jan;61(1):276-286. doi: 10.1002/jmri.29349. Epub 2024 Mar 15.

DOI:10.1002/jmri.29349

PMID:38490945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11401958/

Abstract

BACKGROUND

Left atrial (LA) myopathy is thought to be associated with silent brain infarctions (SBI) through changes in blood flow hemodynamics leading to thrombogenesis. 4D-flow MRI enables in-vivo hemodynamic quantification in the left atrium (LA) and LA appendage (LAA).

PURPOSE

To determine whether LA and LAA hemodynamic and volumetric parameters are associated with SBI.

STUDY TYPE

Prospective observational study.

POPULATION

A single-site cohort of 125 Participants of the multiethnic study of atherosclerosis (MESA), mean age: 72.3 ± 7.2 years, 56 men.

FIELD STRENGTH/SEQUENCE: 1.5T. Cardiac MRI: Cine balanced steady state free precession (bSSFP) and 4D-flow sequences. Brain MRI: T1- and T2-weighted SE and FLAIR.

ASSESSMENT

Presence of SBI was determined from brain MRI by neuroradiologists according to routine diagnostic criteria in all participants without a history of stroke based on the MESA database. Minimum and maximum LA volumes and ejection fraction were calculated from bSSFP data. Blood stasis (% of voxels <10 cm/sec) and peak velocity (cm/sec) in the LA and LAA were assessed by a radiologist using an established 4D-flow workflow.

STATISTICAL TESTS

Student's t test, Mann-Whitney U test, one-way ANOVA, chi-square test. Multivariable stepwise logistic regression with automatic forward and backward selection. Significance level P < 0.05.

RESULTS

26 (20.8%) had at least one SBI. After Bonferroni correction, participants with SBI were significantly older and had significantly lower peak velocities in the LAA. In multivariable analyses, age (per 10-years) (odds ratio (OR) = 1.99 (95% confidence interval (CI): 1.30-3.04)) and LAA peak velocity (per cm/sec) (OR = 0.87 (95% CI: 0.81-0.93)) were significantly associated with SBI.

CONCLUSION

Older age and lower LAA peak velocity were associated with SBI in multivariable analyses whereas volumetric-based measures from cardiac MRI or cardiovascular risk factors were not. Cardiac 4D-flow MRI showed potential to serve as a novel imaging marker for SBI.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

摘要

背景

左心房（LA）肌病被认为通过导致血栓形成的血流动力学变化与无症状性脑梗死（SBI）相关。四维血流磁共振成像（4D-flow MRI）能够对左心房（LA）和左心耳（LAA）进行体内血流动力学定量分析。

目的

确定LA和LAA的血流动力学及容积参数是否与SBI相关。

研究类型

前瞻性观察性研究。

研究对象

动脉粥样硬化多族裔研究（MESA）的125名单中心队列参与者，平均年龄：72.3±7.2岁，男性56名。

场强/序列：1.5T。心脏MRI：电影稳态自由进动序列（bSSFP）和4D-flow序列。脑部MRI：T1加权、T2加权自旋回波序列（SE）和液体衰减反转恢复序列（FLAIR）。

评估

由神经放射科医生根据常规诊断标准，通过脑部MRI在所有无卒中病史的参与者中确定SBI的存在情况，数据基于MESA数据库。从bSSFP数据计算LA的最小和最大容积以及射血分数。放射科医生使用既定的4D-flow工作流程评估LA和LAA中的血流淤滞（体素<10 cm/秒的百分比）和峰值速度（cm/秒）。

统计检验

学生t检验、曼-惠特尼U检验、单因素方差分析、卡方检验。采用自动向前和向后选择的多变量逐步逻辑回归。显著性水平P<0.05。

结果

26名（20.8%）至少有一处SBI。经Bonferroni校正后，患有SBI的参与者年龄显著更大，LAA中的峰值速度显著更低。在多变量分析中，年龄（每10岁）（比值比（OR）=1.99（95%置信区间（CI）：1.30 - 3.04））和LAA峰值速度（每厘米/秒）（OR = 0.87（95%CI：0.81 - 0.93））与SBI显著相关。