Luo Jing, Zhou Hui, Li Yisha, Hou Yangzhen, Yang Ji, LIUYang Tengyu
Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
Hunan Engineering Research Center for Intelligent Medical Imaging, Furong Laboratory, Changsha 410008.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 May 28;50(5):777-792. doi: 10.11817/j.issn.1672-7347.2025.240388.
Patients with connective tissue diseases (CTD) have a high incidence of cardiac involvement, which often presents insidiously and can progress rapidly, making it one of the leading causes of death. Multiparametric cardiovascular magnetic resonance (CMR) provides a comprehensive quantitative evaluation of myocardial injury and is emerging as a valuable tool for detecting cardiac involvement in CTD. This study aims to investigate the correlations between CMR features and serological biomarkers in CTD patients, assess their potential clinical value, and further explore the impact of pre-CMR immunotherapy intensity on CMR-specific parameters, thereby evaluating the role of CMR in the early diagnosis of CTD-related cardiac involvement.
A retrospective analysis was conducted on 72 consecutive CTD patients who underwent CMR at Xiangya Hospital of Central South University between September 2019 and March 2024. Clinical data, serological markers, and CMR parameters were collected. Differences in CMR parameters were compared between CTD patients with positive and negative serological markers. Correlations between serological biomarkers and CMR parameters were analyzed, with subgroup analyses performed for different CTD subtypes. Logistic regression (univariate and multivariate) was applied to explore the effects of pre-CMR immunotherapy intensity on CMR parameters, and receiver operating characteristic (ROC) curve analysis was used to determine cutoff values.
In differential analyses, CTD patients with elevated interleukin (IL)-1β and IL-6 levels exhibited significantly higher myocardial T values compared with those with normal levels (=0.014, =0.012). Elevated IL-10 was associated with a higher prevalence of microvascular lesions on CMR (=0.038). Correlation analysis revealed a significant positive association between high-sensitivity cardiac troponin T (hs-cTnT) and T values (=0.371, =0.009). ROC analysis indicated that when the hs-cTnT threshold was 0.01 ng/mL, the sensitivity and specificity for predicting elevated left ventricular T values were 85.71% and 61.11%, respectively [area under the curve (AUC)=0.767, =0.001]. hs-cTnT and creatine kinase (CK) were also positively correlated with native T values (=0.371, =0.009; =0.364, =0.032). Erythrocyte sedimentation rate (ESR) showed a positive correlation with the percentage of the late gadolinium enhancement (LGE) (=0.236, =0.047). Conversely, hs-cTnT correlated negatively with global radial strain (GRS) (=-0.297, =0.034), while CK correlated negatively with both GRS and global circumferential strain (GCS) (=-0.292, =0.022; =-0.282, =0.027). Among patients with elevated hs-cTnT, the cumulative glucocorticoid dose prior to CMR was negatively associated with elevated T values (=0.997, =0.018), and this correlation remained significant after adjusting for duration of steroid use (=0.997, =0.044). ROC analysis showed that when the cumulative glucocorticoid dose did not exceed 613 mg/mL (prednisone equivalent), the sensitivity and specificity for predicting elevated T values were 90.48% and 77.78%, respectively (AUC=0.862, <0.001).
Several inflammatory biomarkers demonstrate correlations with specific CMR parameters, with hs-cTnT showing the strongest associations across multiple indices. Elevated hs-cTnT suggests a high likelihood of cardiac involvement in CTD patients. Furthermore, pre-CMR immunotherapy intensity significantly influences the specificity of T mapping, indicating its importance in interpreting CMR results. These findings provide critical insights for clinicians in the early recognition, timely intervention, and disease evaluation. Future research should further explore the role of CMR in the assessment of CTD-related cardiac assessment of CTD-related cardiac involvement. Future studies should further explore the role of CMR in evaluating CTD cardiac manifestations and its integration with other clinical data to optimize patient management.
结缔组织病（CTD）患者心脏受累的发生率较高，其往往隐匿起病且进展迅速，是主要死因之一。多参数心血管磁共振（CMR）可对心肌损伤进行全面定量评估，正成为检测CTD患者心脏受累的重要工具。本研究旨在探讨CTD患者CMR特征与血清生物标志物之间的相关性，评估其潜在临床价值，并进一步探究CMR检查前免疫治疗强度对CMR特定参数的影响，从而评估CMR在CTD相关心脏受累早期诊断中的作用。
对2019年9月至2024年3月在中南大学湘雅医院接受CMR检查的72例连续CTD患者进行回顾性分析。收集临床资料、血清学标志物及CMR参数。比较血清学标志物阳性和阴性的CTD患者CMR参数的差异。分析血清生物标志物与CMR参数之间的相关性，并对不同CTD亚型进行亚组分析。应用逻辑回归（单变量和多变量）探讨CMR检查前免疫治疗强度对CMR参数的影响，并采用受试者工作特征（ROC）曲线分析确定临界值。
在差异分析中，白细胞介素（IL）-1β和IL-6水平升高的CTD患者与水平正常者相比，心肌T值显著更高（P = 0.014，P = 0.012）。IL-10升高与CMR上微血管病变的患病率较高相关（P = 0.038）。相关性分析显示，高敏心肌肌钙蛋白T（hs-cTnT）与T值之间存在显著正相关（r = 0.371，P = 0.009）。ROC分析表明，当hs-cTnT阈值为0.01 ng/mL时，预测左心室T值升高的敏感性和特异性分别为85.71%和61.11%[曲线下面积（AUC）= 0.767，P = 0.001]。hs-cTnT和肌酸激酶（CK）也与固有T值呈正相关（r = 0.371，P = 0.009；r = 0.364，P = 0.032）。红细胞沉降率（ESR）与钆延迟增强（LGE）百分比呈正相关（r = 0.236，P = 0.047）。相反，hs-cTnT与整体径向应变（GRS）呈负相关（r = -0.297，P = 0.034），而CK与GRS和整体圆周应变（GCS）均呈负相关（r = -0.292，P = 0.022；r = -0.282，P = 0.027）。在hs-cTnT升高的患者中，CMR检查前糖皮质激素的累积剂量与T值升高呈负相关（r = 0.997，P = 0.018），在调整类固醇使用时间后，这种相关性仍然显著（r = 0.997，P = 0.044）。ROC分析显示，当糖皮质激素累积剂量不超过613 mg/mL（泼尼松等效剂量）时，预测T值升高的敏感性和特异性分别为90.48%和77.78%（AUC = 0.862，P < 0.001）。
几种炎症生物标志物与特定的CMR参数存在相关性，其中hs-cTnT在多个指标中显示出最强的关联。hs-cTnT升高提示CTD患者心脏受累的可能性较大。此外，CMR检查前免疫治疗强度显著影响T映射的特异性，表明其在解释CMR结果中的重要性。这些发现为临床医生进行早期识别、及时干预和疾病评估提供了关键见解。未来的研究应进一步探索CMR在评估CTD相关心脏受累中的作用。未来的研究应进一步探索CMR在评估CTD心脏表现中的作用及其与其他临床数据的整合，以优化患者管理。
