Ajiboye Israel O, Lang Sean M, Taylor Michael D, Banerjee Rupak K
Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, USA.
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Heart Vessels. 2024 Dec 28. doi: 10.1007/s00380-024-02511-5.
Ejection fraction is commonly used to assess Duchenne muscular dystrophy-associated cardiomyopathy (DMDAC), but it may remain normal (wrongly) despite significant myocardial dysfunction in patients. Therefore, better indicators of myocardial dysfunction are needed for longitudinal (with time) assessment and treatment of DMDAC patients. This study evaluates non-invasive LV PV loop-derived elastance, contractility and efficiency in relation to EF for patients developing DMDAC. The current retrospective study includes thirty DMDAC patients who underwent two serial CMR imaging from 2014 to 2023. The patients were divided into EF < 55% and EF ≥ 55%. Brachial pressures from cuff sphygmomanometer and CMR short axis steady-state free-precession images for the LV were acquired, and a non-invasive PV loop algorithm based on temporal elastance was used to derive mean elastance, contractility, and efficiency. While mean elastance and contractility showed moderate correlations (r = 0.56, p < 0.01, and r = 0.65, p < 0.001 respectively), efficiency exhibited a strong correlation with EF (r = 0.97, p < 0.01). Importantly, mean elastance, efficiency, and contractility were significantly lower in the EF < 55% group compared to EF ≥ 55% (p < 0.001). Therefore, these indices could serve as viable diagnostic endpoints for longitudinal evaluation of DMDAC.
射血分数常用于评估杜氏肌营养不良症相关心肌病（DMDAC），但尽管患者存在显著的心肌功能障碍，其射血分数仍可能（错误地）保持正常。因此，需要更好的心肌功能障碍指标来对DMDAC患者进行纵向（随时间）评估和治疗。本研究评估了与射血分数相关的、由左心室压力-容积环得出的无创弹性、收缩性和效率，用于患有DMDAC的患者。当前的回顾性研究纳入了30例在2014年至2023年期间接受了两次连续心脏磁共振成像检查的DMDAC患者。这些患者被分为射血分数<55%和射血分数≥55%两组。通过袖带血压计测量肱动脉血压，并采集左心室的心脏磁共振短轴稳态自由进动图像，使用基于时间弹性的无创压力-容积环算法来得出平均弹性、收缩性和效率。虽然平均弹性和收缩性显示出中等程度的相关性（分别为r = 0.56，p < 0.01和r = 0.65，p < 0.001），但效率与射血分数显示出强相关性（r = 0.97，p < 0.01）。重要的是，与射血分数≥55%的组相比，射血分数<55%的组的平均弹性、效率和收缩性显著更低（p < 0.001）。因此，这些指标可作为DMDAC纵向评估的可行诊断终点。
