心脏磁共振快速评估右心室收缩功能方法在常见原发性心肌病的应用
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摘要
目的比较几种较受认可的磁共振快速评估右心室收缩功能方法的准确性,以寻找最快速、有效评估右心室收缩功能的方法。方法回顾性分析95例原发性心肌病患者(52例原发性扩张型心肌病、43例肥厚型心肌病)的心脏磁共振(CMR)电影图像资料,在CVI42后处理软件上,使用传统金标准方法检测右心室射血分数(RVEF)、快速评估右心功能方法检测三尖瓣环收缩位移(TAPSE)、右室缩短率(RVFS)、右心室面积变化率(RVFAC)及目测评估,分别测量评估右心室收缩功能,使用受试者工作特征曲线(ROC曲线)评估RVEF<45%时各参数的阈值及诊断准确性。RVEF≥45%(58例)与RVEF<45%(37例)时有统计学差异(P <0.05)。ROC曲线评估各快速测量方法在诊断RVEF<45%时均具有较高的诊断准确性,TAPSE、RVFS、RVFAC及目测评估的曲线下面积分别为0.91、0.95、0.94、0.91(医师1)、0.93(医师2),P均<0.05;且均具有较高的灵敏度(分别为TAPSE 78%,RVFS 73%,RVFAC 86%,医师1 84%,医师2 86%)、特异度(分别为TAPSE 88%,RVFS 100%,RVFAC 93%,医师1 98%,医师2 100%),其中RVFAC的灵敏度、特异度最均衡且诊断准确性较高。结论 CMR快速评估常见原发性心肌病患者右心室收缩功能的方法具有较高的诊断准确性,可以选择任一种以快速评估右心室收缩功能,以RVFAC为最佳。
Objective To compare the accuracy of different magnetic resonance methods in the rapid assessment of the right ventricular systolic function, aiming to explore the most rapid and effective assessment approach. Methods The cardiac magnetic resonance( CMR) imaging data of 95 patients with idiopathic cardiomyopathy including 52 cases of idiopathic dilated cardiomyopathy and 43 cases of hypertrophic cardiomyopathy were retrospectively analyzed. On the basis of CVI42 processing software, the right ventricular ejection fraction( RVEF) was measured by the traditional gold standard. The tricuspid annular plane systolic excusion( TAPSE), right ventricular fractional shortening( RVFS) and right ventricular fractional area change(RVFAC) were measured by rapid assessment method. The right ventricular systolic function was measured by visual assessment method. The threshold and diagnostic accuracy of each parameter when diagnosing RVEF < 45% were analyzed by the receiver operating characteristic( ROC) curve. Results The RVEDV/BSA, RVESV/BSA, TAPSE, RVFS and RVFAC significantly differed between 58 cases with RVEF ≥ 45% and 37 cases with RVEF<45%( all P < 0.05). When the RVEF < 45%, the ROC curve revealed that the diagnostic accuracy of each rapid assessment method was relatively high. The area under curve of TAPSE, RVFS, RVFAC and visual assessment were 0.91, 0.95, 0.94, 0.91(Doctor 1) and 0.93(Doctor 2), respectively. All these rapid assessment methods yielded relatively high sensitivity( 78% for TAPSE, 73% for RVFS, 86% for RVFAC, 84% for Doctor 1 and 86% for Doctor 2)and high specificity( 88% for TAPSE, 100% for RVFS, 93% for RVFAC, 98% for Doctor 1 and 100% for Doctor 2). RVFAC had the highest diagnostic accuracy and the most balance between sensitivity and specificity. Conclusions The CMR rapid assessment method yields relatively high diagnostic accuracy in the evaluation of the right ventricular systolic function in patients with common idiopathic cardiomyopathy. Any parameter can be chosen to rapidly assess the right ventricular systolic function, and RVFAC is the optimal parameter.
Objective To compare the accuracy of different magnetic resonance methods in the rapid assessment of the right ventricular systolic function, aiming to explore the most rapid and effective assessment approach. Methods The cardiac magnetic resonance( CMR) imaging data of 95 patients with idiopathic cardiomyopathy including 52 cases of idiopathic dilated cardiomyopathy and 43 cases of hypertrophic cardiomyopathy were retrospectively analyzed. On the basis of CVI42 processing software, the right ventricular ejection fraction( RVEF) was measured by the traditional gold standard. The tricuspid annular plane systolic excusion( TAPSE), right ventricular fractional shortening( RVFS) and right ventricular fractional area change(RVFAC) were measured by rapid assessment method. The right ventricular systolic function was measured by visual assessment method. The threshold and diagnostic accuracy of each parameter when diagnosing RVEF < 45% were analyzed by the receiver operating characteristic( ROC) curve. Results The RVEDV/BSA, RVESV/BSA, TAPSE, RVFS and RVFAC significantly differed between 58 cases with RVEF ≥ 45% and 37 cases with RVEF<45%( all P < 0.05). When the RVEF < 45%, the ROC curve revealed that the diagnostic accuracy of each rapid assessment method was relatively high. The area under curve of TAPSE, RVFS, RVFAC and visual assessment were 0.91, 0.95, 0.94, 0.91(Doctor 1) and 0.93(Doctor 2), respectively. All these rapid assessment methods yielded relatively high sensitivity( 78% for TAPSE, 73% for RVFS, 86% for RVFAC, 84% for Doctor 1 and 86% for Doctor 2)and high specificity( 88% for TAPSE, 100% for RVFS, 93% for RVFAC, 98% for Doctor 1 and 100% for Doctor 2). RVFAC had the highest diagnostic accuracy and the most balance between sensitivity and specificity. Conclusions The CMR rapid assessment method yields relatively high diagnostic accuracy in the evaluation of the right ventricular systolic function in patients with common idiopathic cardiomyopathy. Any parameter can be chosen to rapidly assess the right ventricular systolic function, and RVFAC is the optimal parameter.
引文
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[9]Tong X,Poon J,Li A,Kit C,Yamada A,Shiino K,Ling LF,Choe YH6,Chan J,Lau YK,Ng MY.Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RVfunction:a comparative study to echocardiography.Clin Radiol,2018,73(3):324.e9-324.e18.
[10]谭宁.心肌病的现代概念及其分类.新医学,2010,41(5):329-331.
[11]Richardson P,McKenna W,Bristow M,Maisch B,Mautner B,O'Connell J,Olsen E,Thiene G,Goodwin J,Gyarfas I,Martin I,Nordet P.Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies.Circulation,1996,93(5):841-842.
[12]江添,刘明辉.实时三平面斑点追踪技术评价肥厚型心肌病左心室整体及节段收缩期纵向应变的研究.新医学,2016,47(2):113-116.
[13]杨晓棠,李思进,彭琨,刘起旺,冯艳林,李剑英.MRI评价原发性扩张型心肌病患者左、右心室功能的对照研究.中国医学计算机成像杂志,2009,15(2):138-143.
[14]Buechel EV,Kaiser T,Jackson C,Schmitz A,Kellenberger CJ.Normal right-and left ventricular volumes and myocardial mass in children measured by steadystate free precession cardiovascular magnetic resonance.J Cardiovasc Magn Reson,2009,11:19.
[15]Beygui F,Furber A,Delépine S,Helft G,Metzger JP,Geslin P,Le Jeune JJ.Routine breath-hold gradient echo MRI-derived right ventricular mass,volumes and function:accuracy,reproducibility and coherence study.Int J Cardiovasc Imaging,2004,20(6):509-516.
[16]Nijveldt R,Germans T,McCann GP,Beek AM,van Rossum AC.Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetricapproach:a cardiovascular magnetic resonance study.Eur Radiol,2008,18(11):2399-2405.
[17]Caudron J,Fares J,Vivier PH,Lefebvre V,Petitjean C,Dacher JN.Diagnostic accuracy and variability of three semiquantitative methods for assessing rightventricular systolic function from cardiac MRI in patients with acquired heart disease.Eur Radiol,2011,21(10):2111-2120.
[18]Anavekar NS,Gerson D,Skali H,Kwong RY,Yucel EK,Solomon SD.Two-dimensional assessment of right ventricular function:an echocardiographic-MRI correlativestudy.Echocardiography,2007,24(5):452-456.
[19]Zornoff LA,Skali H,Pfeffer MA,St John Sutton M,Rouleau JL,Lamas GA,Plappert T,Rouleau JR,MoyéLA,Lewis SJ,Braunwald E,Solomon SD;SAVE Investigators.Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction.J Am Coll Cardiol,2002,39(9):1450-1455.
[20]Doesch C,Zompolou C,Streitner F,Haghi D,Schimpf R,Rudic B,Kuschyk J,Schoenberg SO,Borggrefe M,Papavassiliu T.CMR-derived TAPSE measurement:a semi-quantitative method of right ventricular functionassessment in patients with hypertrophic cardiomyopathy.Neth Heart J,2014,22(12):557-564.
[2]Venner C,Selton-Suty C,Huttin O,Erpelding ML,Aliot E,Juillière Y.Right ventricular dysfunction in patients with idiopathic dilated cardiomyopathy:prognosticvalue and predictive factors.Arch Cardiovasc Dis,2016,109(4):231-241.
[3]Merlo M,Gobbo M,Stolfo D,Losurdo P,Ramani F,Barbati G,Pivetta A,Di Lenarda A,Anzini M,Gigli M,Pinamonti B,Sinagra G.The prognostic impact of the evolution of RV function in idiopathic DCM.JACC Cardiovasc Imaging,2016,9(9):1034-1042.
[4]Barkhausen J,Ruehm SG,Goyen M,Buck T,Laub G,Debatin JF.MR evaluation of ventricular function:true fast imaging with steady-state precession versus fastlow-angle shot cine MRimaging:feasibility study.Radiology,2001,219(1):264-269.
[5]张军燕,张兆琪,李传亭,李宇.磁共振电影成像评价左右心室整体收缩功能.中华心血管病杂志,2006,34(12):1085-1088.
[6]Schulz-Menger J,Bluemke DA,Bremerich J,Flamm SD,Fogel MA,Friedrich MG,Kim RJ,von Knobelsdorff-Brenkenhoff F,Kramer CM,Pennell DJ,Plein S,Nagel E.Standardized image interpretation and post processing in cardiovascular magnetic resonance:Society for Cardiovascular Magnetic Resonance(SCMR)board of trustees task force on standardized post processing.J Cardiovasc Magn Reson,2013,15:35.
[7]王静,刘鹏飞.心脏磁共振成像对右心疾病的研究.心血管病学进展,2018,39(2):259-262.
[8]Marcus FI,Mc Kenna WJ,Sherrill D,Basso C,Bauce B,Bluemke DA,Calkins H,Corrado D,Cox MG,Daubert JP,Fontaine G,Gear K,Hauer R,Nava A,Picard MH,Protonotarios N,Saffitz JE,Sanborn DM,Steinberg JS,Tandri H,Thiene G,Towbin JA,Tsatsopoulou A,Wichter T,Zareba W.Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia:proposed modification of the task force criteria.Circulation,2010,121(13):1533-1541.
[9]Tong X,Poon J,Li A,Kit C,Yamada A,Shiino K,Ling LF,Choe YH6,Chan J,Lau YK,Ng MY.Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RVfunction:a comparative study to echocardiography.Clin Radiol,2018,73(3):324.e9-324.e18.
[10]谭宁.心肌病的现代概念及其分类.新医学,2010,41(5):329-331.
[11]Richardson P,McKenna W,Bristow M,Maisch B,Mautner B,O'Connell J,Olsen E,Thiene G,Goodwin J,Gyarfas I,Martin I,Nordet P.Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies.Circulation,1996,93(5):841-842.
[12]江添,刘明辉.实时三平面斑点追踪技术评价肥厚型心肌病左心室整体及节段收缩期纵向应变的研究.新医学,2016,47(2):113-116.
[13]杨晓棠,李思进,彭琨,刘起旺,冯艳林,李剑英.MRI评价原发性扩张型心肌病患者左、右心室功能的对照研究.中国医学计算机成像杂志,2009,15(2):138-143.
[14]Buechel EV,Kaiser T,Jackson C,Schmitz A,Kellenberger CJ.Normal right-and left ventricular volumes and myocardial mass in children measured by steadystate free precession cardiovascular magnetic resonance.J Cardiovasc Magn Reson,2009,11:19.
[15]Beygui F,Furber A,Delépine S,Helft G,Metzger JP,Geslin P,Le Jeune JJ.Routine breath-hold gradient echo MRI-derived right ventricular mass,volumes and function:accuracy,reproducibility and coherence study.Int J Cardiovasc Imaging,2004,20(6):509-516.
[16]Nijveldt R,Germans T,McCann GP,Beek AM,van Rossum AC.Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetricapproach:a cardiovascular magnetic resonance study.Eur Radiol,2008,18(11):2399-2405.
[17]Caudron J,Fares J,Vivier PH,Lefebvre V,Petitjean C,Dacher JN.Diagnostic accuracy and variability of three semiquantitative methods for assessing rightventricular systolic function from cardiac MRI in patients with acquired heart disease.Eur Radiol,2011,21(10):2111-2120.
[18]Anavekar NS,Gerson D,Skali H,Kwong RY,Yucel EK,Solomon SD.Two-dimensional assessment of right ventricular function:an echocardiographic-MRI correlativestudy.Echocardiography,2007,24(5):452-456.
[19]Zornoff LA,Skali H,Pfeffer MA,St John Sutton M,Rouleau JL,Lamas GA,Plappert T,Rouleau JR,MoyéLA,Lewis SJ,Braunwald E,Solomon SD;SAVE Investigators.Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction.J Am Coll Cardiol,2002,39(9):1450-1455.
[20]Doesch C,Zompolou C,Streitner F,Haghi D,Schimpf R,Rudic B,Kuschyk J,Schoenberg SO,Borggrefe M,Papavassiliu T.CMR-derived TAPSE measurement:a semi-quantitative method of right ventricular functionassessment in patients with hypertrophic cardiomyopathy.Neth Heart J,2014,22(12):557-564.