心肌功能指数（MFI）：AL 型心肌病心功能的综合测量指标

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2024-10-15 DOI:10.1016/j.ijcha.2024.101525

Nadia Akhiyat , Vidhu Anand , Vinayak Kumar , Alexander Ryu , Raymond Gibbons , Barry A. Borlaug , Krishnaswamy Chandrasekaran , Omar Abou Ezzeddine , Nandan Anavekar

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引用次数: 0

摘要

背景淀粉样轻链（AL）淀粉样变性是一种可导致局限性心肌病（AL-CM）的全身性疾病。目前的成像技术对检测 AL-CM 的心肌功能障碍并不敏感。我们试图评估一种新型心肌功能障碍标记物（心肌功能指数，MFI）的作用，该标记物是利用舒张期和收缩期左心室（LV）血池和心肌容积的变化获得的。两名独立操作者使用心脏核磁共振成像进行收缩期和舒张期心外膜和心内膜描记，以获得舒张期心肌容积（MVd）和收缩期心肌容积（MVs）。测量心动周期中心肌容积的变化，通过 MVd-MVs+StrokevolumeMVd+LVenddiastolicvolume 计算 MFI。结果与正常队列（n = 101，39 ± 15 岁，61 % 为女性）相比，AL-CM 患者（n = 129，61 ± 10 岁，32 % 为女性）年龄更大，更可能是男性。AL-CM 患者的 MFI 较低（19 % [15; 23] vs 38 % [35; 41]，p < 0.001），MFI < 30 % 可区分 AL-CM，灵敏度为 92 %，特异性为 100 %（AUC 0.98，p < 0.001）。即使在调整了 AL-CM 的常规预后生物标志物后，较高的 MFI 仍与存活率独立相关（HR 0.02，95 % CI 2.23 *104 - 0.24，p < 0.05）。结论MFI是评估左心室功能的一种新指标。MFI是评估左心室功能的新指标，在AL-CM患者中存在异常，可能在风险分层中发挥作用。

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The myocardial function index (MFI): An integrated measure of cardiac function in AL-cardiomyopathy

Background

Amyloid light chain (AL) amyloidosis is a systemic disease that can cause restrictive cardiomyopathy (AL-CM). Current imaging techniques are not sensitive to detect myocardial dysfunction in AL-CM. We sought to evaluate role of a novel marker of myocardial dysfunction (myocardial function index, MFI) obtained using changes in left ventricular (LV) blood pool and myocardial volume in diastole and systole.

Methods

Consecutive patients diagnosed with AL-CM who had underwent cardiac MRI between 2001–2017 were identified and compared to healthy individuals. Two independent operators used cardiac MRI to perform epicardial and endocardial tracings in systole and diastole to obtain myocardial volume in diastole (MVd) and myocardial volume in systole (MVs). Changes in myocardial volumes during the cardiac cycle were measured to calculate the MFI by

\frac{(M V d - M V s) + S t r o k e v o l u m e}{MVd + L V e n d d i a s t o l i c v o l u m e}

. Multivariable analysis was performed to evaluate predictors of all-cause mortality and survival was evaluated using Kaplan Meier analysis.

Results

Patients with AL-CM (n = 129, 61 ± 10 years, 32 % women) were older and more likely to be men compared to the normal cohort (n = 101, 39 ± 15 years, 61 % women). MFI was lower in patients with AL-CM (19 % [15; 23] vs 38 % [35; 41], p < 0.001) and MFI < 30 % discriminated between AL-CM with 92 % sensitivity and 100 % specificity (AUC 0.98, p < 0.001). Higher MFI was independently associated with survival even after adjusting for conventional prognostic biomarkers of AL-CM (HR 0.02, 95 % CI 2.23 *104 – 0.24, p < 0.05). Two independent operators demonstrated high intra and inter-rater correlation in measurements used to calculate MFI.

Conclusion

MFI is a novel metric for assessing LV function. It is abnormal in patients with AL-CM and may play a role in risk stratification.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.