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Title: [Clinical value of left ventricular strain analysis by cardiovascular magnetic resonance in patients with coronary chronic total occlusion].
Author: Zhang LJ, Tian JF, Yang XY, Xu L, He Y, Song XT.
Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2021 Jun 24; 49(6):601-609. PubMed ID: 34126728.
Abstract:
Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m²) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m²). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients. 目的： 探讨应用心脏磁共振（CMR）组织追踪技术定量评估冠状动脉慢性完全闭塞性病变（CTO）患者左心室心肌应变的临床应用价值。 方法： 该研究为回顾性、观察性研究。入选2014年11月至2019年1月在北京安贞医院行CMR检查的单支CTO患者作为病例组（即CTO组），另选取同期经超声心动图、心电图和临床病史等排除的无心血管疾病且CMR无异常表现的人群作为健康对照组（即对照组）。通过电子病历系统提取入选者的年龄、性别、出院诊断等一般临床资料及超声心动图、心电图检查结果。采用组织追踪技术测量左心室心肌应变参数，包括整体径向应变峰值（GPRS）、周向应变峰值（GPCS）和纵向应变峰值（GPLS），并分析CTO靶血管区心肌应变情况。采用灰度阈值5个标准差法测量心肌梗死面积，然后分别根据心肌梗死面积和左心室射血分数（LVEF）将CTO组患者进一步分为心肌梗死面积>10%组和≤10%组，以及LVEF≥50%组和<50%组。比较CTO组及其各亚组与对照组相关参数的差异。 结果： CTO组入选患者52例，男性34例，年龄（54.1±11.7）岁，体重指数（26.2±2.5）kg/m²，对照组入选30人，男性14人，年龄（51.6±12.3）岁，体重指数（25.6±3.3）kg/m²，两组间年龄、性别及体重指数差异均无统计学意义（P均>0.05）。与对照组比较，CTO组患者LVEF、GPRS、GPCS、GPLS均较低（P<0.05），而左心室容积（LVEDV）差异无统计学意义（P=0.32）。CTO组患者中心肌梗死面积>10%组26例、≤10%组26例。与对照组比较，心肌梗死面积≤10%组的CTO患者的LVEF和LVEDV差异均无统计学意义（P均>0.05），而GPRS、GPCS、GPLS均较低（P均<0.05）。与对照组比较，梗死面积>10%组的CTO患者的LVEDV差异无统计学意义（P>0.05），而LVEF、GPRS、GPCS和GPLS均较低（P均<0.05）。与梗死面积≤10%组比较，梗死面积>10%组的CTO患者的LVEF、LVEDV和GPLS差异均无统计学意义（P均>0.05），而GPRS、GPCS则较低（P均<0.05）。CTO组患者中LVEF≥50%组40例，LVEF<50%组12例。与对照组比较，LVEF≥50%组和LVEF<50%组的CTO患者的GPRS、GPCS和GPLS均较低（P均<0.01），LVEF≥50%组的CTO患者的LVEF和LVEDV差异均无统计学意义（P均>0.05），而LVEF<50%组的LVEF较低、LVEDV较大（P均<0.05）。LVEF≥50%组的CTO患者的GPRS、GPCS、GPLS和LVEF均高于LVEF<50%组（P均<0.01），心肌梗死面积小于LVEF<50%组（P<0.01），而LVEDV两组间差异无统计学意义（P=0.07）。CTO组中，前降支闭塞患者21例，靶血管供血心肌节段数126个，供血区域心肌的径向应变峰值（PRS）、周向应变峰值（PCS）和纵向应变峰值（PLS）均较对照组低（P均<0.01）；回旋支闭塞患者7例，靶血管供血心肌节段数35个，靶血管供血区心肌的PRS、PCS和PLS均较对照组低（P均<0.05）；右冠状动脉闭塞患者24例，靶血管供血心肌节段数120个，靶血管供血区心肌的PRS、PCS和PLS均较对照组低（P均<0.01）。21例CTO患者前降支闭塞，其供血的126个心肌节段中梗死面积≤25%的91个（72.2%）、26%~50%的17个（13.5%）、51%~75%的11个（8.7%）、76%~100%的7个（5.6%）。7例CTO患者回旋支闭塞，其供血的35个心肌节段中梗死面积≤25%的31个（88.6%）、26%~75%的4个（11.4%）。24例CTO患者右冠状动脉闭塞，其供血的120个心肌节段中梗死面积≤25%的96个（80.0%）、26%~50%的11个（9.2%）、51%~75%的8个（6.7%）、76%~100%的5个（4.2%）。 结论： 尽管大部分单支CTO病变的患者射血分数保留，但是整体及靶血管区的心肌应变能力已经降低，且梗死面积越大径向和周向应变能力下降越明显，提示存在左心功能早期损害，而CMR组织追踪技术提供了一种更为快捷、可靠的心肌应变分析的手段，具有潜在的临床应用价值。.

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