摘要
目的:探讨心脏磁共振特征追踪(CMR-FT)成像技术定量评估扩张型心肌病(DCM)治疗前后心肌应变情况对预后的预测价值。方法:选取我院2018年4月至2021年4月收治的DCM患者94例,依据指南推荐给予标准治疗并随访6个月,根据是否发生主要不良心血管事件(MACE)分为预后不良组(发生MACE,23例)、预后良好组(未发生MACE,71例),比较两组临床资料、治疗前后心功能指标[左心室射血分数(LVEF)、氨基末端脑钠肽前体(NT-proBNP)]、心肌应变参数[总应变(εs)、被动应变(εe)、主动应变(εa)、左心室收缩期峰值正向应变率(SRs)、左心室舒张早期左心房峰值负向应变率(SRe)、左心室舒张晚期左心房峰值负向应变率(SRa)],分析各心肌应变参数与心功能指标的相关性,评价各心肌应变参数治疗前后差值对预后的影响及预测价值。结果:预后不良组治疗前后LVEF均低于预后良好组[(45.27±3.62)%比(49.82±4.30)%,t=4.572,P<0.05、(48.96±4.15)%比(56.41±5.03)%,t=6.423,P<0.05],NT-proBNP均高于预后良好组[(1275.84±326.55)pg/mL比(1014.79±259.87)pg/mL,t=3.924,P<0.05、(1001.35±241.98)pg/mL比(665.21±202.43)pg/mL,t=6.591,P<0.05];预后不良组治疗前后εs、εe、εa、SRs、SRe、SRa及差值均小于预后良好组(均P<0.05);治疗前后心肌应变参数与LVEF呈正相关,与NT-proBNP呈负相关(均P<0.05);Logistic回归分析显示,心肌应变参数差值对预后均有重要影响(均P<0.05);ROC曲线显示,心肌应变参数差值联合预测优于单独预测(均P<0.05)。结论:DCM患者应用CMR-FT成像技术定量评估心肌应变对预后具有一定预测价值,且为DCM患者预后不良风险提供参考。
Objective:To investigate the predictive value of cardiac magnetic resonance signature tracking(CMR-FT)imaging for quantitative assessment of myocardial strain before and after treatment for dilated cardiomyopathy(DCM)on prognosis.Methods:Ninety-four patients with DCM admitted to our hospital from April 2018 to April 2021 were selected and given standard treatment according to guideline recommendations and followed up for 6 months,and divided into poor prognosis group(MACE occurred,23 cases)and good prognosis group(no MACE occurred,71 cases)according to whether major adverse cardiovascular events(MACE)occurred,and clinical data and cardiac function indexes before and after treatment were compared between the two groups[left ventricular ejection fraction(LVEF),amino-terminal brain natriuretic peptide precursor(NT-proBNP)],myocardial strain parameters[total strain(εs),passive strain(εe),active strain(εa),peak positive left ventricular systolic strain rate(SRs),peak negative left atrial strain rate in early left ventricular diastole(SRe),peak negative left atrial strain rate in late left ventricular diastole(SRa)],to analyze the correlation between each myocardial strain parameter and cardiac function indexes,and to evaluate the prognostic impact and predictive value of the difference of each myocardial strain parameter before and after treatment.Results:LVEF before and after treatment was lower in the poor prognosis group than in the good prognosis group[(45.27±3.62)%versus(49.82±4.30)%,t=4.572,P<0.05,(48.96±4.15)%versus(56.41±5.03)%,t=6.423,P<0.05],and NT-proBNP was higher in the good prognosis group[(1275.84±326.55)pg/mL versus(1014.79±259.87)pg/mL,t=3.924,P<0.05 and(1001.35±241.98)pg/mL versus(665.21±202.43)pg/mL,t=6.591,P<0.05].The pre-and post-treatmentεs,εe,εa,SRs,SRe,SRa and differences were smaller in the poor prognosis group than in the good prognosis group(all P<0.05);myocardial strain parameters were positively correlated with LVEF and negatively correlated with NT-proBNP before and after treatment(all P<0.05);logistic regression analysis showed that myocardial strain parameter differences all had a significant effect on prognosis(all P<Logistic regression analysis showed that the difference in myocardial strain parameters had a significant effect on prognosis(all P<0.05).Conclusion:The application of CMR-FT imaging for quantitative assessment of myocardial strain in patients with DCM has some predictive value for prognosis and provides a reference for the risk of poor prognosis in patients with DCM.
作者
赵冰洋
文梅霞
ZHAO Bingyang;WEN Meixia(Hechi People's Hospital,Guangxi Hechi 547000,China)
出处
《河北医学》
CAS
2023年第6期1020-1026,共7页
Hebei Medicine
基金
广西壮族自治区医学课题计划,(编号:Z20200148)。
