The International Journal of Cardiovascular Imaging ( IF 1.5 ) Pub Date : 2024-02-20 , DOI: 10.1007/s10554-024-03049-3
Marina Raquel Santos 1, 2 , Mariana Santos Silva 2, 3 , Sara Lopes Guerreiro 2 , Daniel Alberto Gomes 2 , Bruno Miguel Rocha 2 , Gonçalo Lopes Cunha 2 , Pedro Nuno Freitas 2 , João Maria Abecasis 2 , Ana Coutinho Santos 2 , Carla Cristina Saraiva 2 , Miguel Mendes 2 , António Miguel Ferreira 2
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Recently, a classification with four types of septal longitudinal strain patterns was described using echocardiography, suggesting a pathophysiological continuum of left bundle branch block (LBBB)-induced left ventricle (LV) remodeling. The aim of this study was to assess the feasibility of classifying these strain patterns using cardiovascular magnetic resonance (CMR), and to evaluate their association with LV remodeling and myocardial scar. Single center registry included LBBB patients with septal flash (SF) referred to CMR to assess the cause of LV systolic dysfunction. Semi-automated feature-tracking cardiac resonance (FT-CMR) was used to quantify myocardial strain and detect the four strain patterns. A total of 115 patients were studied (age 66 ± 11 years, 57% men, 28% with ischemic heart disease). In longitudinal strain analysis, 23 patients (20%) were classified in stage LBBB-1, 37 (32.1%) in LBBB-2, 25 (21.7%) in LBBB-3, and 30 (26%) in LBBB-4. Patients at higher stages had more prominent septal flash, higher LV volumes, lower LV ejection fraction, and lower absolute strain values (p < 0.05 for all). Late gadolinium enhancement (LGE) was found in 55% of the patients (n = 63). No differences were found between the strain patterns regarding the presence, distribution or location of LGE. Among patients with LBBB, there was a good association between strain patterns assessed by FT-CMR analysis and the degree of LV remodeling and LV dysfunction. This association seems to be independent from the presence and distribution of LGE.
中文翻译:
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使用心脏磁共振评估左束支传导阻滞患者的心肌应变模式
最近,使用超声心动图描述了四种类型的间隔纵向应变模式的分类,表明左束支传导阻滞(LBBB)诱导的左心室(LV)重塑的病理生理学连续体。本研究的目的是评估使用心血管磁共振 (CMR) 对这些应变模式进行分类的可行性,并评估它们与左心室重塑和心肌疤痕的关联。单中心登记纳入患有间隔闪现 (SF) 的 LBBB 患者,转诊至 CMR 以评估左室收缩功能障碍的原因。使用半自动特征跟踪心脏共振(FT-CMR)来量化心肌应变并检测四种应变模式。共有 115 名患者接受了研究(年龄 66 ± 11 岁,57% 为男性,28% 患有缺血性心脏病)。在纵向应变分析中,23 例患者 (20%) 被分类为 LBBB-1 期,37 例 (32.1%) 被分类为 LBBB-2 期,25 例 (21.7%) 被分类为 LBBB-3 期,30 例 (26%) 被分类为 LBBB-4 期。较高阶段的患者具有更显着的间隔闪现、更高的左心室容量、更低的左心室射血分数和更低的绝对应变值(全部p<0.05)。 55% 的患者 (n = 63) 发现了晚期钆增强 (LGE)。在 LGE 的存在、分布或位置方面,应变模式之间没有发现差异。在 LBBB 患者中,通过 FT-CMR 分析评估的应变模式与左室重构和左室功能障碍的程度之间存在良好的相关性。这种关联似乎独立于 LGE 的存在和分布。