通过心脏 MRI (CMR) 进行心肌变形分析,产生整体周向和纵向应变(GCS 和 GLS),这种方法越来越多地用于准确量化 Fontan 循环患者的收缩功能和预测临床事件。本研究的目的是使用主成分分析 (PCA) 来研究从应变-时间曲线得出的心肌时间变形模式,以了解超出峰值的潜在应变特征。我们进行这项研究时特别关注主要的单左心室或右心室(SLV 和 SRV)形态。方法和结果:对远离 Fontan 手术并接受随访 CMR 的患者进行标准体积和功能血流动力学分析,包括心肌变形参数(包括 GCS 和 GLS)。我们应用 PCA 以公正的方式研究应变-时间曲线形态并计算患者特定的形状评分。所有变量均进行单变量 Cox 回归分析,以检测复合临床结果,包括死亡、心脏移植、蛋白质丢失性肠病和塑料性支气管炎。共有 122 名平均年龄为 12.7 岁的患者(SLV = 67,SRV = 55)接受了全面的 CMR 分析。PCA 揭示了应变曲线变化的 3 种主要模式,与所研究的单心室形态和应变类型无关。主成分 (PC) 描述了 (1) 应变-时间曲线振幅、(2) 峰值应变时间和 (3) 应变-时间曲线的收缩后斜率的变化。仅考虑 SLV 患者,GCS 是唯一预测临床事件的 CMR 变量(HR 1.46,p = 0.020)。在 SRV 组中,临床事件的显着 CMR 预测因子源自指数舒张末期(HR 1.02,p = 0.023)和收缩末期(HR 1.03,p = 0.022)容量、GCS(HR 1.91,p = 0.003)及其相关的第一组成部分得分(HR 1.20,p = 0.005)、GLS(HR 1.32,p = 0.029)及其第三组成部分得分(HR 1.58,p = 0.017)。CMR 衍生的整体应变测量是 Fontan 循环患者临床结果的敏感标志,特别是具有 SRV 形态的患者。受无偏 PCA 技术启发,SLV 和 SRV 患者特有的心肌应变-时间曲线形态可以进一步帮助预测临床结果。
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Myocardial strain-curve deformation patterns after Fontan operation
Myocardial deformation analysis by cardiac MRI (CMR) yielding global circumferential and longitudinal strain (GCS and GLS) is an increasingly utilized method to accurately quantify systolic function and predict clinical events in patients with Fontan circulation. The purpose of this study was to use principal component analysis (PCA) to investigate myocardial temporal deformation patterns derived from strain–time curves to learn about latent strain features beyond peak values. We conducted the study with specific attention to dominant single left or right ventricle (SLV and SRV) morphologies. Methods and Results: Patients remote from Fontan operation who underwent follow-up CMR were analyzed for standard volumetric and function hemodynamics including myocardial deformation parameters including GCS and GLS. We applied PCA to investigate in an unbiased fashion the strain–time curve morphology and to calculate patient specific shape scores. All variables were subjected to single variable Cox regression analysis to detect composite clinical outcome including death, heart transplant, protein losing enteropathy and plastic bronchitis. A total of 122 patients, (SLV = 67, SRV = 55) with a mean age of 12.7 years underwent comprehensive CMR analysis. The PCA revealed 3 primary modes of strain-curve variation regardless of single ventricle morphology and type of strain investigated. Principle components (PCs) described changes in (1) strain–time curve amplitude, (2) time-to-peak strain, and (3) post-systolic slope of the strain–time curve. Considering only SLV patients, GCS was only CMR variable predictive of clinical events (HR 1.46, p = 0.020). In the SRV group, significant CMR predictors of clinical events were derived indexed end-diastolic (HR 1.02, p = 0.023) and end-systolic (HR 1.03, p = 0.022) volumes, GCS (HR 1.91, p = 0.003) and its related first component score (HR 1.20, p = 0.005), GLS (HR 1.32, p = 0.029) and its third component score (HR 1.58, p = 0.017). CMR derived global strain measures are sensitive markers of clinical outcomes in patients with Fontan circulation, particularly in patients with the SRV morphology. Myocardial strain–time curve morphology specific to SLV and SRV patients inspired by unbiased PCA technique can further aid with predicting clinical outcomes.