CMR-FT量化的左心房应变对高血压合并缺血性卒中的诊断价值

Diagnostic Value of Left Atrial Strain Quantified by CMR-FT in Hypertensive Patients with Ischemic Stroke

摘要: 目的：探讨在高血压患者中心脏磁共振特征跟踪技术(CMR-FT)量化的左心房(LA)应变与缺血性脑卒中(IS)的关系。方法：100例高血压患者据颅脑磁共振检查结果分为无-IS组62例和IS组38例，比较两组患者年龄、性别、身体质量指数(BMI)等一般资料和左心室、左心房心脏磁共振(CMR)功能参数。Logistic回归分析高血压合并IS的影响因素，受试者工作特征(ROC)曲线分析各指标的预测效能。结果：IS组年龄、同型半胱氨酸(Hcy)、LA最小容积(LA Vmin)高于无-IS组(P < 0.05)，存储期、泵血期及导管期的应变、应变率、射血分数低于无-IS组(P < 0.05)。年龄及Hcy、存储期应变是高血压合并IS的独立危险因素，单指标分析时，存储期应变敏感度较高，Hcy诊断特异度最高；联合检测时综合效能较高。结论：年龄、Hcy和存储期应变及其联合指标对高血压伴IS患者具有一定的诊断价值，可优化高血压患者的治疗和管理。

Abstract: Objective: To investigate the relationship between left atrial (LA) strain quantified by cardiac magnetic resonance feature tracking (CMR-FT) and ischemic stroke (IS) in hypertensive patients. Methods: 100 hypertensive patients were divided into a non-IS group of 62 cases and an IS group of 38 cases based on the results of cranial magnetic resonance imaging. General data such as age, gender, and body mass index (BMI), as well as cardiac magnetic resonance (CMR) functional parameters of the left ventricle and left atrium, were compared between the two groups. Logistic regression analysis was used to identify factors influencing IS in hypertensive patients, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive efficacy of each index. Results: The IS group had higher age, homocysteine (Hcy), and minimum left atrial volume (LA Vmin) compared to the non-IS group (P < 0.05), while strain, strain rate, and ejection fraction during the reservoir, pump, and conduit phases were lower than in the non-IS group (P < 0.05). Age, Hcy, and reservoir phase strain were independent risk factors for IS in hypertensive patients. In single-index analysis, reservoir phase strain had higher sensitivity, while Hcy had the highest diagnostic specificity; in combined detection, the comprehensive efficacy was higher. Conclusion: Age, Hcy, reservoir phase strain, and their combined indicators have certain diagnostic value for hypertensive patients with IS and can optimize treatment and management for these patients.