心脏磁共振电影成像在射血分数保留心力衰竭诊治中的应用

目的 探讨心脏磁共振电影成像在评价射血分数保留心力衰竭（HFpEF）左心室舒张功能中的作用。方法 应用心脏磁共振成像获取30例HFpEF患者和15例心功能正常者（对照组）的左心室长轴两腔、三腔、四腔及系列短轴电影图像，绘制左心室容积-时间曲线（VTC）及整体应变曲线，比较两组峰值充盈速率及充盈量，以及整体纵向、径向、周向峰值应变和应变率等参数。结果 与对照组相比，HFpEF患者左心室重构指数（LVRI）增加（0.86±0.15 vs 0.73±0.08，P<0.05），舒张早、晚期峰值充盈速率比（PFR1/PFR2）降低或倒置（0.74±0.14 vs 1.43±0.34，P=0.001），早期充盈量（FV1）及其占总充盈量比例降低（26.24±9.74 vs 31.30±5.17，0.59±0.05 vs 0.69±0.03；P均<0.05），左心室整体纵向峰值应变（GLS）降低[（-14.96±1.79）% vs（-20.96±0.84）%，P<0.01]，整体纵向、径向、周向峰值应变率均降低（0.65±0.16 vs 1.29±0.27，-2.23±0.71 vs-3.80±1.13，1.02±0.14 vs 1.77±0.63；P均<0.05）。结论 通过心脏磁共振获得的LVRI、PFR1/PFR2、FV1和整体周向峰值应变率能够较准确地反映HFpEF左心室舒张功能的改变，对于HFpEF诊治具有较高的临床价值。
Objective To explore the role of cine sequence of cardiac magnetic resonance (CMR) imaging in evaluating left ventricular (LV) diastolic function in patients with heart failure with preserved ejection fraction (HFpEF). Methods LV two-chamber, three-chamber, four-chamber long-axis and series of short-axis cine images were obtained from 30 patients with HFpEF (HFpEF group) and 15 cases with normal cardiac function (control group) using CMR examination. LV volume-time curve (VTC) and global strain curves were drawn. Peak filling rate and peak filling volume, global longitudinal, global radial, global circumferential peak strain and peak diastolic strain rate were compared between the two groups. Results Compared with the control group, LV remodeling index (LVRI) in the HFpEF group was significantly increased (0.86±0.15 vs 0.73±0.08, P<0.05), first peak filling rate/second peak filling rate (PFR1/PFR2) was significantly decreased or even inverted (0.74 ±0.14 vs 1.43±0.34, P=0.001), and first filling volume (FV1) and FV1/total filling volume (FV1/FV) were significantly decreased (26.24±9.74 vs 31.30±5.17, P<0.05; 0.59±0.05 vs 0.69±0.03, P<0.05). Global longitudinal peak strain (GLS) ([-14.96±1.79]% vs[-20.96±0.84]%,P<0.01), global longitudinal diastolic peak strain rate (0.65±0.16 vs 1.29±0.27, P<0.05), global radial diastolic peak strain rate (-2.23±0.71 vs -3.80±1.13, P<0.05) and global circumferential diastolic peak strain rate (GDCSR) (1.02±0.14 vs 1.77±0.63, P<0.05) in the HFpEF group were significantly decreased versus control group. Conclusion LVRI, PFR1/PFR2, FV1 and GDCSR obtained by CMR can accurately evaluate the changes of LV diastolic function in HFpEF, which may play important roles in the diagnosis and treatment of HFpEF