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心脏磁共振特征追踪技术在免疫检查点抑制剂相关性心肌炎患者右心室功能评估中的价值

Value of Cardiac Magnetic Resonance Feature Tracking Technique in Evaluating Right Ventricle Function in Immune Checkpoint Inhibitor Induced Myocarditis

    摘要
  • 摘要:
    目的 探讨心脏磁共振特征追踪(cardiac magnetic resonance feature tracking, CMR-FT)技术在免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)相关性心肌炎患者右心室功能评估中的临床价值。
    方法 将2022年4月—2024年4月在北京协和医院就诊并经心内科医生确诊为ICIs相关性心肌炎, 且右心室射血分数(right ventricular ejection fraction, RVEF)正常的患者纳入心肌炎组。同时, 选择无心血管疾病的健康人群为健康对照组。所有受试者均行心脏磁共振(cardiac magnetic resonance, CMR)检查。测量受试者左心室和右心室心功能参数, 包括左心室射血分数(left ventricular ejection fraction, LVEF)、RVEF、左心室收缩末期容积指数(left ventricular end-systolic volume index, LVESVI)、左心室舒张末期容积指数(left ventricular end-diastolic volume index, LVEDVI)、右心室收缩末期容积指数(right ventricular end-systolic volume index, RVESVI)、右心室舒张末期容积指数(right ventricular end-diastolic volume index, RVEDVI)。同时, 记录左心室和右心室心肌应变指标, 包括左心室整体纵向应变(left ventricular global longitudinal strain, LV-GLS)、左心室整体周向应变(left ventricular global circumferential strain, LV-GCS)、左心室整体径向应变(left ventricular global radial strain, LV-GRS)、右心室整体纵向应变(right ventricular global longitudinal strain, RV-GLS)、右心室整体周向应变(right ventricular global circumferential strain, RV-GCS)和右心室整体径向应变(right ventricular global radial strain, RV-GRS)。
    结果 本研究心肌炎组共纳入30例患者, 健康对照组20例。心肌炎组LVEF为(58.0±6.9)%, 低于健康对照组的(65.4±6.6)%, 差异有统计学意义(P＜0.001);心肌炎组RVEF为(57.2±5.2)%, 健康对照组为(59.6±4.4)%, 差异无统计学意义(P＞0.05)。心肌炎组LV-GLS、LV-GCS、LV-GRS、RV-GLS、RV-GCS和RV-GRS均低于健康对照组, 差异具有统计学意义(P均＜0.001)。
    结论 通过CMR-FT技术获取的右心室心肌应变指标可揭示ICIs相关性心肌炎患者早期右心室功能受损情况, 为临床早期预防和及时干预提供关键依据。

     

    Abstract:
    Objective To investigate the clinical value of cardiac magnetic resonance feature tracking (CMR-FT) technology in the assessment of the right ventricle function in patients with immune checkpoint inhibitor (ICIs)-related myocarditis.
    Methods Patients who visited Peking Union Medical College Hospital from April 2022 to April 2024, were diagnosed as ICIs-related myocarditis by cardiologists, and had normal right ventricular ejection fraction (RVEF) were enrolled in myocarditis group. Meanwhile, healthy individuals without cardiovascular diseases were selected as healthy control group. All subjects underwent cardiac magnetic resonance (CMR) examinations. Cardiac function parameters of the left and right ventricles were measured in the subjects, including left ventricular ejection fraction (LVEF), RVEF, left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), right ventricular end-systolic volume index (RVESVI), and right ventricular end-diastolic volume index (RVEDVI). Additionally, myocardial strain of the left and right ventricles were recorded, encompassing left ventricular global longitudinal strain (LV-GLS), left ventricular global circumferential strain (LV-GCS), left ventricular global radial strain (LV-GRS), right ventricular global longitudinal strain (RV-GLS), right ventricular global circumferential strain (RV-GCS), and right ventricular global radial strain (RV-GRS).
    Results A total of 30 patients were induded in the myocarditis group and 20 in the healthy control group. The LVEF in the myocarditis group was was lower than that in the control group (58.0±6.9)% vs. (65.4±6.6)%, P < 0.001).The RVEF was (57.2±5.2)% in the myocarditis group, and (59.6±4.4)% in the healthy control group, showing no statistically significant difference (P > 0.05). LV-GLS, LV-GCS, LV-GRS, RV-GLS, RV-GCS, and RV-GRS in the myocarditis group were all lower than those in the healthy control group, with statistically significant differences (all P < 0.001).
    Conclusion Right ventricular myocardial strain obtained through CMR-FT technology can reveal early right ventricular cardiac dysfunction in patients with ICIs-related myocarditis, providing crucial evidence for early clinical prevention and timely intervention.

     

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