心肌MRI对肥厚性心肌病患者保留射血分数心衰的评价

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-09-24 DOI:10.1016/j.ejrad.2025.112446

Xuan Ma , Tian Lan , Jiaxin Wang , Shujuan Yang , Shiqin Yu , Zhixiang Dong , Yun Tang , Xingrui Chen , Kankan Zhao , Weipeng Yan , Yanyan Song , Kai Yang , Minjie Lu , Shihua Zhao , Xiuyu Chen

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引用次数: 0

摘要

目的：本研究旨在评估心肌组织特征在肥厚性心肌病（HCM）患者保留射血分数（HFpEF）检测心力衰竭中的应用。方法前瞻性纳入133例连续HCM患者，进行生物标志物检测，测量n端前脑利钠肽（NT-proBNP）浓度，超声心动图评估舒张功能，心脏MRI获取组织特征，包括原生T1值、细胞外体积分数（ECV）和指数ECV （iECV）。结果基于2019年ESC HFA-PEFF诊断算法，75例（56.4%）HCM患者被诊断为HFpEF。与没有HF的HCM患者相比，HFpEF-HCM患者表现出更高的原生T1、ECV和iECV（均p <； 0.05）。原生T1、ECV和iECV与NT-proBNP呈正相关，舒张功能不全患者NT-proBNP升高（p < 0.05）。在ROC分析中，原生T1值（AUC: 0.723; p < 0.001）在心脏mri衍生的LV参数中是一个较强的判别因子，在校正其他临床和影像学变量后，仍然与HFpEF的诊断独立相关（优势比：2.41；95%置信区间：1.32-4.39，每增加1个标准差）。此外，原生T1对HCM中HFpEF的传统标记具有递增价值。结论HCM中T1延长、细胞外体积升高与HFpEF的诊断相关。原生T1是一个独立的鉴别因子，可能在鉴别HFpEF-HCM方面有补充价值。

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Myocardial tissue characterization by cardiac MRI for the evaluation of heart failure with preserved ejection fraction in hypertrophic cardiomyopathy

Purpose

This study aimed to assess the utility of myocardial tissue characteristics, as identified by cardiac magnetic resonance T1 mapping, in detecting heart failure with preserved ejection fraction (HFpEF) in patients with hypertrophic cardiomyopathy (HCM).

Methods

A total of 133 consecutive patients with HCM were prospectively enrolled for biomarker testing to measure N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, echocardiography to evaluate the diastolic function, and cardiac MRI to access tissue characteristics including native T1 values, extracellular volume fraction (ECV), and indexed ECV (iECV).

Results

Seventy-five (56.4 %) HCM patients were diagnosed with HFpEF based on the 2019 ESC HFA-PEFF diagnostic algorithm. Compared to HCM patients without HF, HFpEF-HCM subjects demonstrated greater native T1, ECV, and iECV (all p < 0.05). Native T1, ECV, and iECV were positively correlated with NT-proBNP and elevated in those with diastolic dysfunction (all p < 0.05). In ROC analysis, native T1 value (AUC: 0.723; p < 0.001) was a stronger discriminator among cardiac MRI-derived LV parameters and remained independently related to the diagnosis of HFpEF after adjusting for other clinical and imaging variables (odds ratio: 2.41; 95 % confidence interval: 1.32–4.39, per 1 standard deviation increase). Furthermore, native T1 had incremental value to the traditional markers for identifying HFpEF in HCM.

Conclusions

In HCM, prolonged native T1 and elevated extracellular volume correlated with the diagnosis of HFpEF. Native T1 was an independent discriminator and may have supplementary value in identifying HFpEF-HCM.

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.