心脏磁共振应变分析在临床前期心尖肥厚型心肌病中的应用
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摘要
目的探讨心脏磁共振应变分析在心电图显示宽大倒置T波而心尖部心肌尚未达到15 mm的临床前期心尖肥厚型心肌病患者中的应用,比较其与正常者心肌应变的差异。资料与方法回顾性收集2015年9月—2018年7月北京安贞医院临床前期心尖肥厚型心肌病且行心脏磁共振检查的29例患者,同时将25例正常者作为对照组。应用加拿大Circle Cardiovascular图像软件(CVI42 5.9.0版)进行图像分析,比较两组左心室射血分数(LVEF)、左心室室壁厚度和左心室心肌应变的差异。结果临床前期心尖肥厚型心肌病组的LVEF与对照组比较,差异无统计学意义(68.75%±6.78%比63.64%±6.40%,P=0.06),左心室心尖部厚度高于对照组[(11.71±1.39)mm比(5.63±0.95)mm,P<0.05],其心尖部周向应变低于对照组(-20.34±8.81比-24.68±3.97,P=0.027),心内膜下整体长轴最大纵向应变与心外膜下整体长轴最大纵向应变的差值高于对照组(-2.96±1.74比-1.33±1.34,P<0.01)。结论临床前期心尖肥厚型心肌病患者LVEF保持在相对较高的水平,但心尖部心肌的最大周向应变下降,表明其周向收缩能力下降。心脏磁共振心肌应变分析可为此类患者提供新的诊断依据及诊断方法。
Purpose To investigate the application of cardiac magnetic resonance strain analysis in patients with apical hypertrophic cardiomyopathy who have preclinical wide inverted T wave and apical myocardium not less than 15 mm as displayed in electrocardiogram, and to compare the difference in myocardial strain with normal subjects. Materials and Methods A total of 29 patients with preclinical apical hypertrophic cardiomyopathy who underwent cardiac magnetic resonance imaging from September 2015 to July 2018 in Beijing Anzhen Hospital were retrospectively collected. Meanwhile, 25 normal subjects were included in the control group. Image analysis was performed using the Canadian Circle Cardiovascular image software(CVI42 version 5.9.0), and the difference in left ventricular ejection fraction(LVEF), left ventricular wall thickness and left ventricular myocardial strain between the two groups was compared. Results There was no statistical significance concerning the difference in LVEF between the preclinical apical hypertrophic cardiomyopathy group and the normal group(68.75%±6.78% vs. 63.64%±6.40%, P=0.06), while the left ventricular apical thickness [(11.71±1.39) mm vs.(5.63±0.95) mm, P<0.05] was higher than that of the normal control group, and the circumferential strain of the apex was lower than that of the normal control group(-20.34±8.811 vs.-24.68±3.97, P=0.027). The difference between the maximum longitudinal strain of subendocardial long axis and the maximum longitudinal strain of subepicardial long axis was higher than that of the normal control group(-2.96±1.74 vs.-1.33±1.34, P<0.01). Conclusion The LVEF of patients with preclinical apical hypertrophic cardiomyopathy remains at a relatively high level, but the maximum circumferential strain of the apical myocardium decreased, indicating declined circumferential contractility. Cardiac magnetic resonance myocardial strain analysis can provide new diagnostic basis and diagnostic methods for such patients.
Purpose To investigate the application of cardiac magnetic resonance strain analysis in patients with apical hypertrophic cardiomyopathy who have preclinical wide inverted T wave and apical myocardium not less than 15 mm as displayed in electrocardiogram, and to compare the difference in myocardial strain with normal subjects. Materials and Methods A total of 29 patients with preclinical apical hypertrophic cardiomyopathy who underwent cardiac magnetic resonance imaging from September 2015 to July 2018 in Beijing Anzhen Hospital were retrospectively collected. Meanwhile, 25 normal subjects were included in the control group. Image analysis was performed using the Canadian Circle Cardiovascular image software(CVI42 version 5.9.0), and the difference in left ventricular ejection fraction(LVEF), left ventricular wall thickness and left ventricular myocardial strain between the two groups was compared. Results There was no statistical significance concerning the difference in LVEF between the preclinical apical hypertrophic cardiomyopathy group and the normal group(68.75%±6.78% vs. 63.64%±6.40%, P=0.06), while the left ventricular apical thickness [(11.71±1.39) mm vs.(5.63±0.95) mm, P<0.05] was higher than that of the normal control group, and the circumferential strain of the apex was lower than that of the normal control group(-20.34±8.811 vs.-24.68±3.97, P=0.027). The difference between the maximum longitudinal strain of subendocardial long axis and the maximum longitudinal strain of subepicardial long axis was higher than that of the normal control group(-2.96±1.74 vs.-1.33±1.34, P<0.01). Conclusion The LVEF of patients with preclinical apical hypertrophic cardiomyopathy remains at a relatively high level, but the maximum circumferential strain of the apical myocardium decreased, indicating declined circumferential contractility. Cardiac magnetic resonance myocardial strain analysis can provide new diagnostic basis and diagnostic methods for such patients.
引文
[1]Sakamoto T,Tei C,Murayama M,et al.Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy(AAH)of the left ventricle.Echocardiographic and ultrasono-cardiotomographic study.Jpn Heart J,1976,17(5):611-629.
[2]Yamaguchi H,Ishimura T,Nishiyama S,et al.Hypertrophic nonobstructive cardiomyopathy with giant negative T waves(apical hypertrophy):ventriculographic and echocardiographic features in 30 patients.Am J Cardiol,1979,44(3):401-412.
[3]Ho HH,Lee KL,Lau CP,et al.Clinical characteristics of and long-term outcome in Chinese patients with hypertrophic cardiomyopathy.Am J Med,2004,116(1):19-23.
[4]Authors/Task Force members,Elliott PM,Anastasakis A,et al.2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy:the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.
[5]中华医学会心血管病学分会,中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心肌病诊断与治疗指南.中华心血管病杂志,2017,45(12):1015-1032.
[6]Elliott P,Andersson B,Arbustini E,et al.Classification of the cardiomyopathies:a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J,2008,29(2):270-276.
[7]Maron BJ,Towbin JA,Thiene G,et al.Contemporary definitions and classification of the cardiomyopathies-an American Heart Association Scientific Statement from the Council on Clinical Cardiology,Heart Failure and Transplantation Committee;Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups;And Council on Epidemiology and Prevention.Circulation,2006,113(14):1807-1816.
[8]Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHAguideline for the diagnosis and treatment of hypertrophic cardiomyopathy:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2011,58(25):2703-2738.
[9]Wu B,Lu M,Zhang Y,et al.CMR assessment of the left ventricle apical morphology in subjects with unexplainable giant T-wave inversion and without apical wall thickness≥15mm.Eur Heart J Cardiovasc Imaging,2017,18(2):186-194.
[10]Flett AS,Maestrini V,Milliken D,et al.Diagnosis of apical hypertrophic cardiomyopathy:T-wave inversion and relative but not absolute apical left ventricular hypertrophy.Int JCardiol,2015,183:143-148.
[11]Klarich KW,Jost CH,Binder J,et al.Risk of death in longterm follow-up of patients with apical hypertrophic cardiomyopathy.Am J Cardiol,2013,111(12):1784-1791.
[12]Khalid S,Sundhu M,Sarma A,et al.Management of a rare variant of hypertrophic cardiomyopathy.Cureus,2018,10(1):e2074.
[13]Eriksson MJ,Sonnenberg B,Woo Anna,et al.Long-term outcome in patients with apical hypertrophic cardiomyopathy.J Am Coll Cardiol,2002,39(4):638-645.
[14]Suzuki J,Watanabe F,Takenaka K,et al.New subtype of apical hypertrophic cardiomyopathy identified with nuclear magnetic resonance imaging as an underlying cause of markedly inverted T waves.J Am Coll Cardiol,1993,22(4):1175-1181.
[15]American College of Cardiology Foundation/American Heart Association Task Force on Practice,American Association for Thoracic Surgery,American Society of Echocardiography,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg,2011,142(6):e153-203.
[16]Authors/Task Force members,Elliott PM,Anastasakis A,et al.2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.
[17]Suzuki J,Shimamoto R,Nishikawa J,et al.Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy:a long term analysis with nuclear magnetic resonance imaging.J Am Coll Cardiol,1999,33(1):146-151.
[18]Fattori R,Biagini E,Lorenzini M,et al.Significance of magnetic resonance imaging in apical hypertrophic cardiomyopathy.Am J Cardiol,2010,105(11):1592-1596.
[19]Moon JC,Fisher NG,Mckenna WJ,et al.Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography.Heart,2004,90(6):645-649.
[20]袁思殊,李志伟,夏黎明.心尖肥厚型心肌病的MRI与超声心动图对比研究.磁共振成像,2015,6(3):187-193.
[21]Jeung MY,Germain P,Croisille P,et al.Myocardial tagging with MR imaging:overview of normal and pathologic findings.Radiographics,2012,32(5):1381-1398.
[22]Smiseth OA,Torp H,Opdahl A,et al.Myocardial strain imaging:how useful is it in clinical decision making?Eur Heart J,2016,37(15):1196-1207.
[23]Claus P,Omar AMS,Pedrizzetti G,et al.Tissue tracking technology for assessing cardiac mechanics:principles,normal values,and clinical applications.JACC Cardiovasc Imaging,2015,8(12):1444-1460.
[24]Reddy M,Thatai D,Bernal J,et al.Apical hypertrophic cardiomyopathy:potential utility of strain imaging.Eur JEchocardiogr,2008,9(4):560-562.
[25]María,Cristina,Saccheri,et al.Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy.World JCardiol,2017(4):363-370.
[26]Hamada S,Schroeder J,Hoffmann R,et al.Prediction of outcomes in patients with chronic ischemic cardiomyopathy by layer-specific strain echocardiography:a proof of concept.J Am Soc Echocardiogr,2016,29(5):412-420.
[27]Hsu EW,Muzikant AL,Matulevicius SA,et al.Magnetic resonance myocardial fiber-orientation mapping with direct histological correlation.Am J Physiol,1998,274(5 Pt 2):H1627-1634.
[28]王姿,冯泽豪,武睿,等.心肌肥厚性疾病的心肌环周应变与左心室功能的相关性.中国医学影像学杂志,2018,26(5):341-346.
[29]Urbano-Moral JA,Rowin EJ,Maron MS,et al.Investigation of global and regional myocardial mechanics with 3-dimensional speckle tracking echocardiography and relations to hypertrophy and fibrosis in hypertrophic cardiomyopathy.Circ Cardiovasc Imaging,2014,7(1):11-19.
[2]Yamaguchi H,Ishimura T,Nishiyama S,et al.Hypertrophic nonobstructive cardiomyopathy with giant negative T waves(apical hypertrophy):ventriculographic and echocardiographic features in 30 patients.Am J Cardiol,1979,44(3):401-412.
[3]Ho HH,Lee KL,Lau CP,et al.Clinical characteristics of and long-term outcome in Chinese patients with hypertrophic cardiomyopathy.Am J Med,2004,116(1):19-23.
[4]Authors/Task Force members,Elliott PM,Anastasakis A,et al.2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy:the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.
[5]中华医学会心血管病学分会,中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心肌病诊断与治疗指南.中华心血管病杂志,2017,45(12):1015-1032.
[6]Elliott P,Andersson B,Arbustini E,et al.Classification of the cardiomyopathies:a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J,2008,29(2):270-276.
[7]Maron BJ,Towbin JA,Thiene G,et al.Contemporary definitions and classification of the cardiomyopathies-an American Heart Association Scientific Statement from the Council on Clinical Cardiology,Heart Failure and Transplantation Committee;Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups;And Council on Epidemiology and Prevention.Circulation,2006,113(14):1807-1816.
[8]Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHAguideline for the diagnosis and treatment of hypertrophic cardiomyopathy:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2011,58(25):2703-2738.
[9]Wu B,Lu M,Zhang Y,et al.CMR assessment of the left ventricle apical morphology in subjects with unexplainable giant T-wave inversion and without apical wall thickness≥15mm.Eur Heart J Cardiovasc Imaging,2017,18(2):186-194.
[10]Flett AS,Maestrini V,Milliken D,et al.Diagnosis of apical hypertrophic cardiomyopathy:T-wave inversion and relative but not absolute apical left ventricular hypertrophy.Int JCardiol,2015,183:143-148.
[11]Klarich KW,Jost CH,Binder J,et al.Risk of death in longterm follow-up of patients with apical hypertrophic cardiomyopathy.Am J Cardiol,2013,111(12):1784-1791.
[12]Khalid S,Sundhu M,Sarma A,et al.Management of a rare variant of hypertrophic cardiomyopathy.Cureus,2018,10(1):e2074.
[13]Eriksson MJ,Sonnenberg B,Woo Anna,et al.Long-term outcome in patients with apical hypertrophic cardiomyopathy.J Am Coll Cardiol,2002,39(4):638-645.
[14]Suzuki J,Watanabe F,Takenaka K,et al.New subtype of apical hypertrophic cardiomyopathy identified with nuclear magnetic resonance imaging as an underlying cause of markedly inverted T waves.J Am Coll Cardiol,1993,22(4):1175-1181.
[15]American College of Cardiology Foundation/American Heart Association Task Force on Practice,American Association for Thoracic Surgery,American Society of Echocardiography,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg,2011,142(6):e153-203.
[16]Authors/Task Force members,Elliott PM,Anastasakis A,et al.2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.
[17]Suzuki J,Shimamoto R,Nishikawa J,et al.Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy:a long term analysis with nuclear magnetic resonance imaging.J Am Coll Cardiol,1999,33(1):146-151.
[18]Fattori R,Biagini E,Lorenzini M,et al.Significance of magnetic resonance imaging in apical hypertrophic cardiomyopathy.Am J Cardiol,2010,105(11):1592-1596.
[19]Moon JC,Fisher NG,Mckenna WJ,et al.Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography.Heart,2004,90(6):645-649.
[20]袁思殊,李志伟,夏黎明.心尖肥厚型心肌病的MRI与超声心动图对比研究.磁共振成像,2015,6(3):187-193.
[21]Jeung MY,Germain P,Croisille P,et al.Myocardial tagging with MR imaging:overview of normal and pathologic findings.Radiographics,2012,32(5):1381-1398.
[22]Smiseth OA,Torp H,Opdahl A,et al.Myocardial strain imaging:how useful is it in clinical decision making?Eur Heart J,2016,37(15):1196-1207.
[23]Claus P,Omar AMS,Pedrizzetti G,et al.Tissue tracking technology for assessing cardiac mechanics:principles,normal values,and clinical applications.JACC Cardiovasc Imaging,2015,8(12):1444-1460.
[24]Reddy M,Thatai D,Bernal J,et al.Apical hypertrophic cardiomyopathy:potential utility of strain imaging.Eur JEchocardiogr,2008,9(4):560-562.
[25]María,Cristina,Saccheri,et al.Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy.World JCardiol,2017(4):363-370.
[26]Hamada S,Schroeder J,Hoffmann R,et al.Prediction of outcomes in patients with chronic ischemic cardiomyopathy by layer-specific strain echocardiography:a proof of concept.J Am Soc Echocardiogr,2016,29(5):412-420.
[27]Hsu EW,Muzikant AL,Matulevicius SA,et al.Magnetic resonance myocardial fiber-orientation mapping with direct histological correlation.Am J Physiol,1998,274(5 Pt 2):H1627-1634.
[28]王姿,冯泽豪,武睿,等.心肌肥厚性疾病的心肌环周应变与左心室功能的相关性.中国医学影像学杂志,2018,26(5):341-346.
[29]Urbano-Moral JA,Rowin EJ,Maron MS,et al.Investigation of global and regional myocardial mechanics with 3-dimensional speckle tracking echocardiography and relations to hypertrophy and fibrosis in hypertrophic cardiomyopathy.Circ Cardiovasc Imaging,2014,7(1):11-19.