心脏磁共振对不同步和心肌瘢痕的评估可预测心脏再同步治疗后功能分级的改善。
Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy.
作者信息
Bilchick Kenneth C, Dimaano Veronica, Wu Katherine C, Helm Robert H, Weiss Robert G, Lima Joao A, Berger Ronald D, Tomaselli Gordon F, Bluemke David A, Halperin Henry R, Abraham Theodore, Kass David A, Lardo Albert C
机构信息
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
出版信息
JACC Cardiovasc Imaging. 2008 Sep;1(5):561-8. doi: 10.1016/j.jcmg.2008.04.013.
OBJECTIVES
We tested a circumferential mechanical dyssynchrony index (circumferential uniformity ratio estimate [CURE]; 0 to 1, 1 = synchrony) derived from magnetic resonance-myocardial tagging (MR-MT) for predicting clinical function class improvement following cardiac resynchronization therapy (CRT).
BACKGROUND
There remains a significant nonresponse rate to CRT. MR-MT provides high quality mechanical activation data throughout the heart, and delayed enhancement cardiac magnetic resonance (DE-CMR) offers precise characterization of myocardial scar.
METHODS
MR-MT was performed in 2 cohorts of heart failure patients with: 1) a CRT heart failure cohort (n = 20; left ventricular ejection fraction of 0.23 +/- 0.057) to evaluate the role of MR-MT and DE-CMR prior to CRT; and 2) a multimodality cohort (n = 27; ejection fraction of 0.20 +/- 0.066) to compare MR-MT and tissue Doppler imaging septal-lateral delay for assessment of mechanical dyssynchrony. MR-MT was also performed in 9 healthy control subjects.
RESULTS
MR-MT showed that control subjects had highly synchronous contraction (CURE 0.96 +/- 0.01), but tissue Doppler imaging indicated dyssynchrony in 44%. Using a cutoff of <0.75 for CURE based on receiver-operator characteristic analysis (area under the curve: 0.889), 56% of patients tested positive for mechanical dyssynchrony, and the MR-MT CURE predicted improved function class with 90% accuracy (positive and predictive values: 87%, 100%); adding DE-CMR (% total scar <15%) data improved accuracy further to 95% (positive and negative predictive values: 93%, 100%). The correlation between CURE and QRS duration was modest in all cardiomyopathy subjects (r = 0.58, p < 0.001). The multimodality cohort showed a 30% discordance rate between CURE and tissue Doppler imaging septal-lateral delay.
CONCLUSIONS
The MR-MT assessment of circumferential mechanical dyssynchrony predicts improvement in function class after CRT. The addition of scar imaging by DE-CMR further improves this predictive value.
目的
我们测试了一种基于磁共振心肌标记（MR-MT）得出的圆周机械不同步指数（圆周均匀率估计值[CURE]；范围为0至1，1表示同步），以预测心脏再同步治疗（CRT）后临床功能分级的改善情况。
背景
CRT仍存在显著的无反应率。MR-MT可提供整个心脏高质量的机械激活数据，而延迟强化心脏磁共振成像（DE-CMR）能精确表征心肌瘢痕。
方法
对两组心力衰竭患者进行了MR-MT检查：1）CRT心力衰竭队列（n = 20；左心室射血分数为0.23±0.057），以评估CRT前MR-MT和DE-CMR的作用；2）多模态队列（n = 27；射血分数为0.20±0.066），比较MR-MT和组织多普勒成像测定的室间隔-侧壁延迟以评估机械不同步。还对9名健康对照者进行了MR-MT检查。
结果
MR-MT显示，对照者有高度同步收缩（CURE为0.96±0.01），但组织多普勒成像显示44%存在不同步。根据受试者工作特征分析（曲线下面积：0.889），以CURE<0.75为临界值，56%的患者机械不同步检测呈阳性，且MR-MT的CURE预测功能分级改善的准确率为90%（阳性预测值和阴性预测值分别为87%、100%）；加入DE-CMR（总瘢痕百分比<15%）数据后，准确率进一步提高至95%（阳性预测值和阴性预测值分别为93%、100%）。在所有心肌病受试者中，CURE与QRS波时限之间的相关性中等（r = 0.58，p<0.001）。多模态队列显示，CURE与组织多普勒成像测定的室间隔-侧壁延迟之间存在30%的不一致率。
结论
MR-MT对圆周机械不同步的评估可预测CRT后功能分级的改善情况。加入DE-CMR的瘢痕成像可进一步提高这种预测价值。
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