MR特征追踪技术评价心房颤动患者左心房功能的初步研究
A preliminary study of left ventricular function assessement in patients with atrial fibrillation by MR feature tracking technique
目的 应用心脏MR特征追踪技术(FT-CMR)初步评价心房颤动(简称房颤)患者的左心房应变及应变率,探讨该技术评估左心房功能的临床应用价值.方法 2014年12月至2015年8月收集30例阵发性房颤患者(阵发性房颤组)、30例持续性房颤患者(持续性房颤组)和22名健康体检者(正常对照组).所有受试者均行心脏MR检查,扫描采用真实稳态自由进动(SSFP)序列.应用离线心血管分析软件分别检测FT-CMR参数:左心房应变、应变率参数和容积功能参数.应变、应变率参数包括左心房总应变(Εs)、左心房被动应变(Εe)、左心房主动应变(Εa)、左心房正向应变率峰值(SRs)、舒张早期左心房负向应变率峰值(SRe)、舒张晚期左心房负向应变率峰值(SRa).容积功能参数包括左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房总射血分数(LATEF)、左心房被动射血分数(LAPEF)、左心房主动射血分数(LAAEF).阵发性房颤组、持续性房颤组、对照组间的一般资料比较应用χ2检验或方差分析,房颤组和对照组、阵发性房颤组和持续性房颤组各参数比较应用独立样本t检验,左心房应变及应变率测量观察者内、观察者间的重复性分析采用组内相关系数(ICC)评价.结果 与对照组比较,房颤组LAVmax、LAVmin明显增大,差异有显著统计学意义(t=9.737、7.889,P值均<0.001);但两组LATEF、LAPEF比较,差异无统计学意义,LAAEF比较差异有统计学意义(t=-4.762,P<0.001).房颤组和对照组比较,房颤组Es、Ee、Ea、SRs、SRe、SRa绝对值较对照组明显减小,两组差异均有统计学意义(t值分别为-7.732、-6.610、-6.493、-7.546、6.864、5.917,P值均<0.001).与阵发性房颤组比较,持续性房颤组LAVmax、LAVmin明显增大,LATEF、LAPEF显著减小,差异有统计学意义(t值分别为-4.575、-5.524、4.002、4.028,P值均<0.001),两组LAAEF比较,差异无统计学意义;两组应变及应变率比较,持续性房颤组Es、Ee、Ea、SRs、SRe、SRa绝对值较阵发性房颤组明显减小,两组差异均有统计学意义(t值分别为4.310、3.128、4.465、5.496、-3.290、-3.863,P值均<0.001).随机抽取受试者的左心房应变及应变率参数,观察者内、观察者间均有良好的可重复性,(ICC值分别为0.85~0.94、0.81~0.90).结论 通过FT-CMR技术可以评价房颤患者左心房应变及应变率的改变;房颤患者左心房储存、管道、助力泵功能均受损;持续性房颤患者较阵发性房颤患者左心房功能受损进一步加重.
更多Objective To explore the clinical application value of left atrial function with feature tracking cardiac magnetic resonance imaging (FT-CMR) by evaluating preliminarily left atrial strain and strain rate in patients with atrial fibrillation. Methods Thirty patients with paroxysmal atrial fibrillation, thirty patients with persistent atrial fibrillation and twenty-two healthy subjects were enrolled. All the subjects underwent cardiac magnetic resonance imaging with the real steady-state free precession(SSFP) sequence. FT-CMR parameters included left atrial strain and strain rate parameters, left atrial volume and function parameters were detected by using offline cardiovascular analysis software, respectively. Left atrial strain and strain rate parameters included left atrial total strain(Εs), passive strain(Εe), active strain(Εa), peak positive strain rate(SRs), peak early negative strain rate(SRe)and peak late negative strain rate(SRa). Volume and function parameters included maximum of left atrial volume(LAVmax), minimum of left atrial volume(LAVmin), total left atrial emptying fraction(LATEF), passive left atrial emptying fraction(LAPEF)and active left atrial emptying fraction(LAAEF). The differences in the general data among the paroxysmal atrial fibrillation group, the persistent atrial fibrillation group and the control group were compared by usingχ2 test or ANOVA analysis. The differences in all parameters between the atrial fibrillation group and the control group, the paroxysmal atrial fibrillation group and the persistent atrial fibrillation group were compared by using independent t test. Left atrial strain and strain rate parameters on an intra-observer and inter-observer were determined by intraclass correlation coefficient(ICC)analyses. Results Compared to control group, LAVmax and LAVmin in atrial fibrillation group were significantly increased(t=9.737,7.889,P<0.001);The LATEF and LAPEF had no significant difference, the LAAEF in two groups had statistically significant difference(t=-4.762,P<0.001).The absolute value of Es, Ee, Ea, SRs, SRe, SRa in atrial fibrillation group were significantly reduced than in control group(t=-7.732,-6.610,-6.493,-7.546, 6.864, 5.917,P<0.001). Compared with paroxysmal atrial fibrillation group, LAVmax and LAVmin in persistent atrial fibrillation group were increased obviously, LATEF and LAPEF were significantly decreased, and the differences were statistically significant(t=-4.575,-5.524, 4.002, 4.028,P<0.001).The LAAEF in two groups had no statistically significant difference. Compared with strain and strain rate in two groups, absolute value of Es, Ee, Ea, SRs, SRe, SRa in persistent atrial fibrillation group significantly decreased than in paroxysmal atrial fibrillation(t=4.310, 3.128, 4.465, 5.496,-3.290,-3.863,P<0.001). The intra-group and inter-group had well correlation coefficients between the observers in the left atrial strain and strain rate parameters of the subjects(ICC=0.85—0.94,0.81—0.90). Conclusions FT-CMR technique can be used to assess the left atrial strain and strain rate in patients with atrial fibrillation;Left atrial reservoir, conduit and booster-pump functions in patients with atrial fibrillation were impaired. Patients with persistent atrial fibrillation had worse left atrial function throughout the entire cardiac cycle compared with those with paroxysmal atrial fibrillation.
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