肥厚型心肌病静息心肌灌注与应变的相关性研究

A Study on the Correlation of Resting Myocardial Perfusion and Strain in Hypertrophic Cardiomyopathy

摘要: [目的] 本文探讨肥厚型心肌病基于心脏磁共振图像获得的静息灌注指标与心脏磁共振特征追踪(CMR-FT)技术量化的左室心肌应变的相关性研究。[方法] 采用历史队列研究的方法，纳入2015年1月~2024年1月经临床及心脏磁共振(CMR)确诊为HCM的患者，丈量舒张末期心肌厚度(EDTH)，绘制左心室基底部、中部及心尖部的血池–信号强度心肌灌注曲线，获得各节段的灌注参数，包括：达峰时间、心肌信号强度最大上升斜率、峰值信号强度(T_peak、Slope_max、SI_peak)，通过CVI42 Strain模块获得左室心肌应变参数包括整体纵向、径向、周向峰值应变(GLS、GRS、GCS)。根据EDTH，将HCM组各心肌节段分为非肥厚亚组和肥厚亚组。采用独立样本t检验比较组间SIpeak、Slopemax和tpeak等参数。检验灌注参数和应变参数的相关关系采用皮尔逊相关性分析。[结果] ① 肥厚节段组(625段)、非肥厚节段组(751段) tpeak分别为(100.40 ± 82.43)、(32.06 ± 111.34)，Slopemax分别为(32.01 ± 12.32)、(108.63 ± 103.30)，SIpeak分别为(1095.54 ± 566.68)、(1146.89 ± 590.79)。其中肥厚节段较非肥厚节段tpeak升高(P < 0.01)，Slopemax降低(P < 0.01)；而SIpeak在两组之间差异无统计学意义。② Slopemax与GLS呈负相关(r = −0.385, P < 0.001)；SIpeak与GLS呈负相关(r = −0.579, P < 0.001)；SIpeak与GCS呈负相关(r = −0.261, P < 0.001)。[结论] ① 3.0 T MR心肌灌注成像能可靠显示出心肌节段微循环功能异常，具有早期显示HCM患者冠脉微循环障碍的能力。② CMR-FT技术可用于评价HCM患者左室心肌应变的异常，与灌注参数的联合运用能更好的为HCM患者提供更全面的危险分层。

Abstract: Objective: This paper explores the correlation between the resting perfusion indices obtained based on cardiac magnetic resonance images in hypertrophic cardiomyopathy and the left ventricular myocardial strain quantified by the cardiac magnetic resonance feature tracking (CMR-FT) technique. Methods: A historical cohort study was adopted. Patients diagnosed with HCM clinically and by cardiac magnetic resonance (CMR) from January 2015 to December 2024 were included. The end-diastolic myocardial thickness (EDTH) was measured. The blood pool-signal intensity myocardial perfusion curves of the base, middle, and apex of the left ventricle were drawn. The maximum slope (Slopemax), time to peak (tpeak), and peak signal intensity (SIpeak) of the myocardial signal intensity for each segment were obtained. The left ventricular myocardial strain parameters including global radial, circumferentia, longitudinalpeak strain (GRS, GCS, GLS) were obtained through the CVI42 Strain module. According to EDTH, each myocardial segment in the HCM group is based on whether the myocardial wall is greater than 15 mm. Independent sample t-tests were used to compare parameters, such as SIpeak, Slopemax, and tpeak between groups. Pearson correlation analysis is used in statistics. Results: ① For the group with myocardial wall thickness greater than or equal to 15 mm (625 segments) and the group with myocardial wall thickness less than 15 mm (751 segments), the tpeak was (100.40 ± 82.43) and (32.06 ± 111.34), respectively; the Slopemax was (32.01 ± 12.32) and (108.63 ± 103.30), respectively; the SIpeak was (1095.54 ± 566.68) and (1146.89 ± 590.79), respectively. Compared with the non-hypertrophic segment group, the tpeak was significantly higher in the hypertrophic segment group (P < 0.01), and the Slopemax was lower (P < 0.01). ② Slopemax was negatively correlated with GLS (r = −0.385, P < 0.001); SIpeak was negatively correlated with GLS (r = −0.579, P < 0.001) and GCS (r = −0.261, P < 0.001). Conclusion: ① 3.0 T MR myocardial perfusion imaging can reliably demonstrate abnormal microcirculation function of myocardial segments and has the capability to reveal coronary microcirculation disorders in HCM patients at an early stage. ② The CMR-FT technique can be utilized to evaluate the abnormal left ventricular myocardial strain in HCM patients. The combined application with perfusion parameters can better provide a more comprehensive risk stratification for HCM patients.