Correlation between T1 Mapping and Feature Tracking in Hypertrophic Cardiomyopathy
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摘要:
目的 探讨肥厚型心肌病（hypertrophic cardiomyopathy，HCM）患者T1mapping与特征追踪的相关性。 方法 回顾性收集2016年1月至2021年7月在云南省第一人民医院住院的86例HCM患者的心脏磁共振（cardiovascular magnetic resonance，CMR）数据，对比钆延迟增强（late gadolinium enhancement，LGE）阳性组（n = 59）与LGE阴性组（n = 27）患者增强前后T1值、心肌细胞外容积比率（extracellular volume，ECV）、纵向应变（longitudinal strain，LS）、圆周应变（circumferential strain，CS）、径向应变（radial strain，RS）和应变率参数差异。 结果 （1）LGE阳性组患者年龄小，NYHA Ⅲ～Ⅳ级比例高，舒张末期最大室壁厚度和左心室质量指数大（P < 0.05）；（2）LGE（+）组增强前T1值较LGE（−）组大，LGE阳性组ECV值较LGE阴性组高（P < 0.05）；（3）.LGE阳性组中整体纵向应变（global longitudinal strain，GLS）与左心室质量指数、左室舒张末期最大室壁厚度、LGE%、T1值、和ECV呈负性相关（分别为r = −0.418**，P = 0.008；r = −0.711**，P = 0.021；r = −0.621**，P = 0.015；r = −0.372**，P = 0.020；r = −0.583**，P = 0.010）。 结论 HCM患者心肌增强后，LGE阳性者GLS降低，后者与左心室舒张末期容积、左心室质量指数、舒张末期最大室壁厚度、LGE%、以及增强前的T1值和ECV呈明显负相关。 Abstract:Objective To explore the correlation between T1mapping and feature tracking in patients with Hypertrophic Cardiomyopathy （HCM）. Methods Cardiac magnetic resonance （CMR） data were retrospectively collected from 86 HCM patients hospitalized at Yunnan Provincial First People's Hospital between January 2016 and July 2021. The differences in T1 values before and after contrast enhancement, extracellular volume （ECV）, longitudinal strain （LS）, circumferential strain （CS）, radial strain （RS）, and strain rate parameters were compared between the late gadolinium enhancement （LGE）-positive group （59 cases） and LGE-negative group （27 cases）. Results （1） Patients in the LGE-positive group were younger with a higher proportion of NYHA class III-IV, larger end-diastolic maximal wall thickness, and greater left ventricular mass index （P < 0.05）; （2） Pre-contrast T1 values were higher in the LGE（+） group compared to the LGE（-） group, and ECV values were elevated in the LGE-positive group （P < 0.05）; （3） In the LGE-positive group, global longitudinal strain （GLS） showed negative correlations with left ventricular mass index, left ventricular end-diastolic maximal wall thickness, LGE%, T1 value, and ECV （r = −0.418**, P = 0.008; r = −0.711**, P = 0.021; r = −0.621**, P = 0.015; r = −0.372**, P = 0.020; r = −0.583**, P = 0.010, respectively）. Conclusion In HCM patients with myocardial enhancement, GLS is reduced in LGE-positive cases, which shows significant negative correlations with left ventricular end-diastolic volume, left ventricular mass index, end-diastolic maximal wall thickness, LGE%, and pre-contrast T1 value and ECV. -
图 1 肥厚型心肌病患者心脏磁共振成像
A：LGE阳性；B～D：特征追踪显示GLS、GCS、GRS明显降低；E～F：增强前T1值及ECV值明显增加；G：LGE阴性；H～J：特征追踪显示GLS、GCS、GRS轻度降低；K～L：增强前T1值及ECV值轻度增加。
Figure 1. Cardiac magnetic resonance imaging in patients with hypertrophic cardiomyopathy
图 2 LGE阳性组患者中整体纵向应变（GLS）与LGE%（A）、增强后T1值（B）、ECV（C）、左心室舒张末期最大室壁厚度（D、E）和左心室质量指数（F）相关性散点图
Figure 2. LGE-positive group, global longitudinal strain （GLS） and LGE%（A）, post-enhanced T1 value（B）, ECV（C）, LVEDMWT（D,E） and LVMI（F） correlation scatter plot
表 1 肥厚型心肌病患者LGE阳性组与LGE阴性组一般临床资料的比较[n （%）/（$ \bar x \pm s $）/M（Q1，Q3）]
Table 1. Comparison of general clinical data of two groups[n （%）/（$ \bar x \pm s $）/M（Q1，Q3）]
项目 LGE阴性组 （n = 27） LGE阳性组 （n = 59） X2/t/Z P 男性 17（62.9） 51（86.4） 1.032 0.658 年龄（岁） 50.7 ± 17.1 41.4 ± 15.2 −1.074 0.027* 收缩压（mmHg） 133.75 ± 12.17 140.00 ± 21.64 2.836 0.53 舒张压（mmHg） 91.50 ± 8.99 87.91 ± 13.96 3.170 0.161 NT-proBNP （ng/L） 865.2（451.2， 1597.2 ）4967.5 （1303.4 ，8183.6 ）65.471 0.012* 肌酐（μmol/L） 87.75 ± 19.02 80.64 ± 13.34 1.035 0.314 心肌肌钙蛋白I（μg/L） 0.175（0.053，0.321） 0.898（0.247，1.783） 7.230 0.040* NHYA心功能III/IV 0 36（59） 1.000 0.000* 症状 胸痛 15（50） 26（74） 0.791 0.312 晕厥 2（7） 14（18） −1.173 0.020* 呼吸困难 10（43） 37（62.7） 0.716 0.044* NT-proBNP：N末端B型利钠肽前体；NHYA：纽约心脏病协会；*P < 0.05。 
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表 2 两组肥厚型心肌病患者CMR检查结果比较（$\bar x \pm s $）
Table 2. Comparison of imaging findings between the two groups（$\bar x \pm s $）
项目 LGE阴性组 （n = 27） LGE阳性组 （n = 59） t P 左室射血分数（%） 69.6 ± 4.8 63.2 ± 7.5 0.714 0.037* 心脏指数（L/（min·m²） 2.98 ± 0.68 2.6 ± 0.92 0.990 0.001* 左心室舒张末期容积（mL/m2） 139.37 ± 24.25 163.02 ± 72.13 −0.133 0.039* 左心室收缩末期容积（mL/m2） 58.42 ± 34.78 45.87 ± 13.93 −0.962 0.073 每搏输出量（mL/m2） 116.00 ± 9.67 94.11 ± 11.75 0.234 0.239 左心室舒张末期最大室壁厚度（cm） 1.82 ± 0.21 1.96 ± 0.46 −2.975 0.024* 左心室质量指数（g/m2） 81.03 ± 11.87 137.53 ± 14.16 −8.006 0.001* *P < 0.05。
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表 3 肥厚型心肌病LGE阳性组与LGE阴性组患者的T1mapping值比较（$\bar x \pm s $）
Table 3. Comparison of T1mapping between LGE-positive group and LGE-nagative group in hypertrophic cardiomyopathy （$\bar x \pm s $）
项目 LGE 阴性组 （n = 27） LGE 阳性组 （n = 59） t P 增强前T1值（ms） 1214.62 ± 330.251392.74 ± 284.52−2.351 0.027* 增强后T1值（ms） 765.71 ± 103.40 893.23 ± 165.42 0.593 0.053 ECV（%） 0.24 ± 0.07 0.49 ± 0.06 −1.490 0.014* *P < 0.05。
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表 4 肥厚型心肌病LGE阳性组与LGE阴性组患者特征追踪值比较（$\bar x \pm s $）
Table 4. Comparison of feature values between LGE-positive group and LGE-nagative group in hypertrophic cardiomyopathy （$\bar x \pm s $）
项目 LGE 阴性组 （n = 27） LGE 阳性组 （n = 59） t P 收缩期峰值局部应变（%） 纵向应变 −6.3 ± 2.7 −9.1 ± 4.7 −1.579 0.023* 圆周应变 −11.2 ± 5.3 −17.4 ± 3.9 −7.804 0.001* 径向应变 12.6 ± 4.2 19.3 ± 4.1 −4.453 0.006* 收缩期峰值局部应变率（s-1） 纵向应变率 −89.4 ± 15.6 −119.4 ± 24.7 −8.903 < 0.001* 圆周应变率 −95.0 ± 12.3 −139.2 ± 15.9 −9.542 < 0.001* 径向应变率 81.9 ± 8.0 141.3 ± 22.5 −8.750 < 0.001* *P < 0.05。
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