心脏磁共振衍生的左心房应变参数对CKD患者合并HFpEF的预测价值

doi:10.3760/cma.j.cn441417-20240621-15019

摘要/Abstract

摘要：

目的　探讨心脏磁共振特征衍生的左心房应变参数对慢性肾脏病（CKD）患者合并射血分数保留型心力衰竭（HFpEF）的预测价值。方法　回顾性分析2020年5月至2024年1月西安凤城医院接收的130例CKD合并HFpEF患者，纳入观察组，其中男82例，女48例，年龄（46.97±10.21）岁；另选取同期100例CKD患者纳入对照组，其中男60例，女40例，年龄（48.02±11.67）岁。两组患者均行心脏磁共振成像、MRI斑点追踪分析检测获取左心房僵硬指数（LASI）、左心房充盈指数（LAFI）等指标，收集两组一般资料，采用Pearson相关性分析评估LASI、LAFI与心肌肌钙蛋白T（cTnT）、N末端脑钠肽前体（NT-proBNP）水平的相关性，并通过受试者操作特征曲线（ROC）评估LASI、LAFI对CKD患者合并HFpEF的预测价值。采用χ²检验、独立样本t检验、秩和检验进行统计学分析。结果　两组在收缩压、舒张压、高血压、糖尿病、cTnT、NT-proBNP、尿素、肌酐、估算肾小球滤过率（eGFR）方面差异均有统计学意义（均P<0.05）。观察组LASI、LAFI高于对照组［0.66（0.44，0.94）比0.21（0.16，0.31），2.95（1.89，4.78）比1.75（1.32，2.10）］，差异均有统计学意义（Z=11.615、7.326，均P<0.05）。相关性分析结果显示：LASI、LAFI与cTnT、NT-proBNP水平均呈正相关（均P<0.05）。ROC分析结果显示：LASI、LAFI预测CKD患者合并HFpEF的曲线下面积分别为0.947、0.782。结论　心脏磁共振特征衍生的左心房应变参数LASI与LAFI在CKD患者合并HFpEF的评估中有预测价值。

关键词:

慢性肾脏病, 射血分数保留型心力衰竭, 心脏磁共振特征, 左心房应变参数, 预测价值

Abstract:

Objective　To investigate the predictive values of cardiac MRI-derived left atrial strain parameters for heart failure with preserved ejection fraction (HFpEF) in patients with chronic kidney disease (CKD). Methods　A retrospective analysis was conducted on 130 patients with CKD and HFpEF admitted to Xi'an Fengcheng Hospital from May 2020 to January 2024, who were included in the observation group, including 82 males and 48 females, with an age of (46.97±10.21) years old. Another 100 patients with CKD during the same period were selected and included in the control group, including 60 males and 40 females, with an age of (48.02±11.67) years old. Both groups underwent cardiac MRI and MRI speckle tracking analysis to obtain indicators such as left atrial stiffness index (LASI) and left atrial filling index (LAFI). The general data of both groups were collected. Pearson correlation analysis was used to evaluate the correlations between LASI, LAFI and the levels of cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The predictive values of LASI and LAFI for HFpEF in CKD patients were assessed through the receiver operating characteristic curve (ROC). Statistical analysis was conducted using the χ² test, independent sample t test, and rank sum test. Results　There were statistically significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, hypertension, diabetes, cTnT, NT-proBNP, urea, creatinine, and estimated glomerular filtration rate (eGFR) (all P<0.05). The LASI and LAFI values in the observation group were higher than those in the control group [0.66 (0.44, 0.94) vs. 0.21 (0.16, 0.31), 2.95 (1.89, 4.78) vs. 1.75 (1.32, 2.10)], with statistically significant differences (Z = 11.615 and 7.326, both P<0.05). The correlation analysis results showed that LASI and LAFI were positively correlated with the levels of cTnT and NT-proBNP (all P<0.05). The ROC analysis results showed that the areas under the curves of LASI and LAFI in predicting the presence of HFpEF in CKD patients were 0.947 and 0.782, respectively. Conclusion　Cardiac MRI-derived left atrial strain parameters, LASI and LAFI, have predictive values in assessing HFpEF in CKD patients.

Key words:

Chronic kidney disease, Heart failure with preserved ejection fraction, Cardiac MRI features, Left atrial strain parameters, Predictive value

李莉郑建民李剑项行林张英.

心脏磁共振衍生的左心房应变参数对CKD患者合并HFpEF的预测价值 [J]. 国际医药卫生导报, 2025, 31(15): 2562-2567.

Li Li, Zheng Jianmin, Li Jian, Xiang Xinglin, Zhang Ying.

Predictive values of cardiac MRI-derived left atrial strain parameters for HFpEF in patients with CKD [J]. International Medicine and Health Guidance News, 2025, 31(15): 2562-2567.

参考文献

[1] 江煜旻,黄岚,冯涛.达格列净对老年2型糖尿病合并射血分数保留型心力衰竭患者心、肾功能的影响[J].西北药学杂志,2024,39(3):110-114. DOI:10.3969/j.issn.1004-2407. 2024.03.019.
[2] 马聪,徐志伟,高彦琳,等.射血分数保留型心力衰竭患者血浆纤维蛋白原水平与易损期预后的预测价值研究[J].现代检验医学杂志,2023,38(4):180-185,200. DOI:10.3969/j.issn.1671-7414.2023.04.033.
[3] 刘秋颖,张云山,王璐璐.左室舒张功能不全分级与临床H2FPEF评分诊断HFpEF的比较研究[J].中国超声医学杂志,2022,38(5):529-532. DOI:10.3969/j.issn.1002-0101. 2022.05.014.
[4] 田迪,张靖雨,熊梓琦,等.心脏磁共振特征衍生的左心房应变及应变率参数用于中国健康成人的初步研究[J].临床放射学杂志,2023,42(9):1453-1458. DOI:10.13437/j.cnki.jcr.2023.09.019.
[5] Bo K, Gao Y, Zhou Z, et al. Incremental prognostic value of left atrial strain in patients with heart failure[J]. ESC Heart Fail, 2022, 9(6):3942-3953. DOI: 10.1002/ehf2.14106.
[6] 李贵森.2019年«中国慢性肾脏病矿物质和骨异常诊治指南»解读[J].诊断学理论与实践,2020,19(3):229-231. DOI:10.16150/j.1671-2870.2020.03.005.
[7] 庄晓峰,陈还珍,黄晓红.«欧洲心力衰竭杂志»2020年第1-6期亮点解读[J].中华心力衰竭和心肌病杂志,2020,4(3):197-201. DOI:10.3760/cma.j.cn.101460-20200910- 00092.
[8] 陈乐昀,游濠乐,郑炜平.Peguero-Lo Presti指数对射血分数保留型心力衰竭的诊断价值[J].实用心电学杂志,2024,33(2):122-127. DOI:10.13308/j.issn.2095-9354. 2024.02.004.
[9] 李海禹,李云鹏.恩格列净联合标准治疗方案治疗射血分数保留型心力衰竭的药物经济学评价[J].河南医学研究,2023,32(16):3003-3008. DOI:10.3969/j.issn.1004- 437X.2023.16.031.
[10] 贺恬宇,武丽娜,师文强,等.三尖瓣环收缩期位移与肺动脉收缩压比值评估肥厚型心肌病合并射血分数保留型心力衰竭患者右心功能[J].中华超声影像学杂志,2024,33(2):126-133. DOI:10.3760/cma.j.cn131148-20231025- 00182.
[11] Schönbauer R, Hana F, Duca F, et al. Right atrial phasic function in heart failure with preserved ejection fraction: cardiac magnetic resonance feature tracking and outcomes[J]. J Clin Med, 2023, 12(16):5179. DOI: 10.3390/jcm12165179.
[12] 刘修颖,孙阳,冉海涛,等.二维斑点追踪技术评价不同等级左心室舒张功能不全心力衰竭患者的右心室功能[J].中华超声影像学杂志,2020,29(7):564-570. DOI:10.3760/cma.j.cn131148-20200105-00011.
[13] Benjamin MM, Khalil M, Munir MS, et al. Association of left atrial size and function by cardiac magnetic resonance imaging with long term outcomes in patients with hypertrophic cardiomyopathy[J]. Int J Cardiovasc Imaging, 2023, 39(6):1181-1188. DOI: 10.1007/s10554-023-02814-0.
[14] van de Wouw J, Broekhuizen M, Sorop O, et al. Chronic kidney disease as a risk factor for heart failure with preserved ejection fraction: a focus on microcirculatory factors and therapeutic targets[J]. Front Physiol, 2019, 10:1108. DOI: 10.3389/fphys.2019.01108.
[15] 姜凤霞,杨顺实,吴柳,等.实时三维超声心动图和二维斑点追踪成像评价慢性心力衰竭患者CRT术后早期疗效的对比研究[J].临床心血管病杂志,2018,34(1):57-60. DOI:10.13201/j.issn.1001-1439.2018.01.013.
[16] Vos JL, Raafs AG, van der Velde N, et al. Comprehensive cardiovascular magnetic resonance-derived myocardial strain analysis provides independent prognostic value in acute myocarditis[J]. J Am Heart Assoc, 2022, 11(19):e025106. DOI: 10.1161/JAHA.121.025106.
[17] 钟向云.基于左心房僵硬度指数的列线图模型对高龄慢性心力衰竭患者发生心脏不良事件的预测价值[J].广西医学,2023,45(3):267-271. DOI:10.11675/j.issn.0253-4304. 2023.03.03.
[18] Houard L, Amzulescu MS, Colin G, et al. Prognostic value of pulmonary transit time by cardiac magnetic resonance on mortality and heart failure hospitalization in patients with advanced heart failure and reduced ejection fraction[J]. Circ Cardiovasc Imaging, 2021, 14(1):e011680. DOI: 10.1161/CIRCIMAGING.120.011680.
[19] 叶露薇,尹立雪,王胰,等.二维纵向应变评价甲状腺功能亢进合并阵发性房颤患者左心房功能的应用价值[J].中国超声医学杂志,2023,39(11):1252-1256. DOI:10.3969/j.issn.1002-0101.2023.11.018.
[20] Mavrakanas TA, Khattak A, Wang W, et al. Association of chronic kidney disease with preserved ejection fraction heart failure is independent of baseline cardiac function[J]. Kidney Blood Press Res, 2019, 44(5):1247-1258. DOI: 10.1159/000502874.
[21] 赵晓莹,郑月,赵新湘,等.左室整体功能指数对肥厚型心肌病心源性猝死风险分层的价值及与钆延迟增强关系[J].实用放射学杂志,2023,39(10):1597-1601. DOI:10.3969/j.issn.1002-1671.2023.10.008.
[22] 马怀敏,王志方.血清生物标志物联合超声心动图预测老年ST段抬高型心肌梗死合并射血分数保留型心力衰竭的临床价值[J].中国心血管病研究,2022,20(1):41-46. DOI:10.3969/j.issn.1672-5301.2022.01.008.
[23] 刘硕,刘改玲,舒锦,等.二维斑点追踪超声心动图在评价老年心力衰竭患者心功能和二维整体应变中的作用[J].临床和实验医学杂志,2016,15(17):1744-1746. DOI:10.3969/j.issn.1671-4695.2016.17.031.
[24] 肖为为,高雪,何垚,等.左心房应变衍生参数预测慢性肾病射血分数保留型心力衰竭[J].中国医学影像技术,2023,39(9):1326-1330. DOI:10.13929/j.issn.1003-3289. 2023.09.011.
[25] Katahira M, Fukushima K, Kiko T, et al. Prognostic significance of left atrial strain combined with left ventricular strain using cardiac magnetic resonance feature tracking in patients with heart failure with preserved ejection fraction[J]. Heart Vessels, 2024, 39(5):404-411. DOI: 10.1007/s00380-023-02351-9.