心脏磁共振特征追踪成像技术在单心室术后心肌应变力评估中的应用研究

doi:10.16150/j.1671-2870.2019.05.005

摘要/Abstract

摘要：

目的：使用心脏磁共振（cardiac magnetic resonance, CMR）特征追踪成像（feature tracking, FT）技术,比较左心室型单心室（single left ventricle, SLV）组、右室型单心室（single right ventricle, SRV）组的Fontan术后患儿与健康儿童间的心肌应变力差异。方法：回顾性分析22例Fontan手术后的单心室病例,其平均年龄为（11.18±4.22）岁;平均MRI随访的时间为（6.41±2.91）年;其中6例为SLV;16例为SRV。另选取10名年龄匹配的健康儿童志愿者,作为应变力的正常值对照组。所有研究对象行CMR检查时,采集两腔、四腔和短轴的电影图像,并计算纵向、周向、径向的总体应变力。比较 3组间的心功能和应变力差异,并应用Bland-Altman方法比较单心室术后病例的组间一致性。结果：Fontan术后患儿与健康儿童比较,舒张末容积指数（end-diastole volumindex, EDVi）[（117.79±56.82） mL比（73.24±13.77） mL]及射血分数（ejection fraction, EF）[（49.61±15.32）%比（60.95±5.94）%]差异有统计学意义（P<0.05）。SLV组与SRV组的比较中,EF差异没有统计学意义（P>0.05）。SLV组、SRV组与健康对照组的应变力比较中,整体纵向应变力[（-20.24±1.90）%、（-12.75±3.67）%、（-9.06±5.93）%]差异皆有统计学意义（P<0.05）。Fontan术后组整体的纵向及周向应变力较之于径向应变力具有更好的一致性。结论：CMR-FT可作为一种评价复杂先心病Fontan术后心肌运动的方法。相比射血分数,整体的纵向应变力可以作为评价SLV和SRV患者心肌收缩功能的参考值。

关键词: 单心室, 特征追踪成像技术, 心肌应变力, 儿童

Abstract:

Objective: To compare 2D global strain between single left ventricle (SLV) group, single right ventricle (SRV) group after Fontan operation and normal healthy controls using feature tracking (FT) of cardiac magnetic resonance (CMR). Methods: Twenty two patients with single ventricle received Fontan operation with a mean age of (11.18±4.22) years and performing cardiac MRI(CMR) after Fontan operation between July 1, 2015 and January 30, 2017 were retrospectively analyzed. The mean year of MRI follow-up after surgery was (6.41±2.91) years. Of the 22 single ventricle patients, 6 were dominant left ventricle, 16 were 22 dominant right ventricle. Ten age-matched healthy children performing CMR were served as controls for providing reference values of strain. CMR function and ventricle strain comparisons were performed between SLV group, SRV group and control group. Bland-Altman method was used to compare the consistence among the groups. Results: End-diastolic volume index (117.79±56.82) mL versus (73.24±13.77) mL and ejection fraction(EF)(49.61±15.32)% versus (60.95±5.94)% were significantly different between healthy controls and Fontan operation repaired group(P<0.05). The comparison of SLV group and SRV group showed no significant difference in EF(49.00±17.68)% versus (48.0±13.77)% (P>0.05). In the comparison of strain among SLV, SRV and healthy control groups, the global longitudinal strain (-20.24±1.90) for SLV versus (-12.75±3.67) for SRV versus (-9.06±5.93) for controls was signi-ficantly different (P<0.05). The global longitudinal and circumferential strain of Fontan operation repaired groups had good consistence, and were better than radial strain. Conclusions: CMR-FT can be used as a method to evaluate cardiac function of complex congenital heart disease after Fontan operation. Compared with the ejection fraction, the 2D global longitudinal strain can be used as a reference value for evaluating the myocardial contraction function in single ventricle patients.

Key words: Single ventricle, Feature-tracking, Strain, Children

中图分类号:

R725.4

胡立伟, 孙爱敏, 王谦, 郭辰, 欧阳荣珍, 姚小芬, 钟玉敏. 心脏磁共振特征追踪成像技术在单心室术后心肌应变力评估中的应用研究[J]. 诊断学理论与实践, 2019, 18(05): 509-514.

HU Liwei, SUN Aimin, WANG Qian, GUO Chen, OUYANG Rongzhen, YAO Xiaofen, ZHONG Yumin. Application of cardiac magnetic resonance feature-tracking in assessment of postoperative ventricular strain after repairing of single ventricle with Fontan operation[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(05): 509-514.

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参数	术后组(n=22)	健康对照组(n=10)	P值	SLV 组(n=6)	SRV 组(n=16)	P值
年龄 (年)	11.18±4.22	10.80±2.41	0.620	9.33±3.01	12.56±4.25	0.249
男/女	15/6	5/5	/	4/2	12/4	/
术后随访时间(年）	6.41±2.91		/	5.28±1.6	6.93±3.26	0.154
心率(次/分)	88±12	73±15	0.237	90±14	86±10	0.910
舒张末容积^a)(mL)	117.79±56.82	73.24±13.77	0.013	136.56±62.57	101.38±49.15	0.047
收缩末容积^a)(mL)	66.13±56.91	28.36±5.51	0.133	78.01±68.35	57.53±43.54	0.461
每博量体积^a)（mL）	54.96±19.02	44.88±10.55	0.350	64.63±18.55	43.76±11.67	0.122
EF(%）	49.61±15.32	60.95±5.94	0.036	49.00±17.68	48.0±13.77	0.935
心肌质量(g)	79.34±50.39	75.69±21.13	0.699	78.81±43.02	81.88±59.80	0.883

2D整体应变力	健康对照组左心室（n=10）	SLV 组(n=6)	SRV 组(n=16)	P 值
纵向应变力	-20.24±1.90	-12.75±3.67	-9.06±5.93	0.039
周向应变力	-17.51±2.05	-14.87±4.63	-14.34±4.70	0.506
径向应变力	36.86±6.21	30.22±10.23	27.57±13.36	0.555