基于心脏磁共振组织追踪初步探究左心房功能预测缺血性心脏病患者预后的价值

目的:初步探究左心房功能预测缺血性心脏病患者出现主要不良心血管事件(MACEs)的价值。方法:回顾性搜集2018年10月-2020年7月共30名确诊缺血性心脏病患者,在二腔心、四腔心层面分别勾画左心房储存期、导管期以及泵血期的心内膜、心外膜轮廓,得到各期左心房容积,采用心脏磁共振组织追踪技术自动生成左心房应变-时间曲线以及应变率-时间曲线并得到左心房三期射血分数、应变以及应变率。采用受试者操作特征(ROC)曲线计算左心房功能参数对于缺血性心脏病患者出现MACEs的预测价值。采用Bland-Altman图评价两位有心脏磁共振诊断经验的医生测量左心房功能参数的一致性。结果:MACEs组左心房储存期射血分数[(37.85±13.86)%vs.(48.40±10.95)%,P=0.028]、应变[13.40(7.25,15.80)%vs. 19.20(13.38,24.68)%,P=0.011],导管期应变[4.6(2.65,7.38)%vs. 9.2(6.5,11.20)%,P=0.003]以及泵血期应变率[-0.65(-1.3,-0.5)/s vs.-1.55(-1.83,-1.00)/s...

The prognostic value of left atrial function assessed by cardiovascular magnetic resonance tissue tracking in ischemic heart disease

Objective:To explore the prognostic value of left atrial(LA)function in major adverse cardiovascular events(MACEs)after ischemic heart disease(IHD).Methods:A total of 30 patients with IHD diagnosed in our hospital from October 2018 to July 2020 were consecutively recruited.The LA reservoir,conduit and booster volumes were derived from two-chamber and four-chamber by cardiac magnetic resonance tissue tracking(CMR-TT).The strain-time curve and strain rate-time curve of LA were generated automatically by CVI42,and then ejection fraction(EF),strain and strain rate of three phases were calculated.The prognostic value of LA function parameters were evaluated by curve of receiver operating characteristic(ROC).Bland-Altman methods was used to analyze the repeatability of LA function parameters measured by two radiologists specialized in CMR diagnosis.Results:During follow-ups,MACEs always occurred in patients with lower LA reservoir EF[(37.85±13.86)%vs.(48.40±10.95)%,P=0.028]and strain[13.40(7.25,15.80)%vs.19.20(13.38,24.68)%,P=0.011],conduit strain[4.6(2.65,7.38)%vs.9.2(6.5,11.20)%,P=0.003],booster strain rate[-0.65(-1.3,-0.5)/s vs.-1.55(-1.83,-1.00)/s,P=0.003].The LA volume index of MACEs[(68.54±19.84)mL/m2 vs.(39.22±11.68)mL/m2,(42.93±14.84)mL/m2 vs.(20.69±7.75)mL/m2,(54.21±21.44)mL/m2 vs.(29.57±10.94)mL/m2]was significantly higher than that of non-MACEs(P<0.001).ROC curves showed LA conduit strain,LA reservoir strain and LA booster strain rate(AUC>0.75,P<0.05),which reminded certain value for prognosis.The two doctors who were blinded to patients'information measured LA functional parameters,which showed good intra-and inter-group consistency.Conclusion:The increase of LA volume index and decrease of LA strain of three phases provide certain prognostic value for the occurrence of MACEs after IHD.