Study Of Left Heart Strain In Heart Failure With Preserved Ejection Fraction-hypertensive Heart Disease By Cardiac Magnetic Resonance Feature Tracking Technology

Purpose:To explore the diagnostic value of left atrial and left ventricular myocardial strain based on cardiac magnetic resonance feature tracking(CMR-FT)technology in heart failure with preserved ejection fraction-hypertensive heart disease(HFpEF-HHD).Methods:24 cases of HFPEF-HHD group,25 cases of hypertensive heart disease(HHD)group,and 23 cases of the healthy control group were retrospectively collected.All patients received cardiac ultrasound examination,cardiac magnetic resonance(CMR)examination and Laboratory markers of cardiac function detection,for example,NTpro BNP.The function module of CVI42 cardiac post-processing software was used to calculate the left ventricular function indicators of the three groups of subjects.After the left ventricular inner and outer membrane was delineated on short-axis cine sequence,left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular enddiastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI)and left ventricular mass index(LVMI)can be obtained.After the left atrium inner and outer membrane was delineated on long-axis two-chamber and longaxis four-chamber cine sequence,left atrial volume index(LAVI)can be obtained The function long axis module of CVI42 cardiac post-processing software was used to calculate the left atrial ejection fraction(LAEF)of the three groups of subjects.The volume-time curve of the left atrium can be obtained by delineating the inner and outer membrane of the left atrium on long-axis two-chamber and long-axis four-chamber cine sequences.The total ejection fraction of the left atrium(LAEF Total),the passive ejection fraction of left atrium(LAEF Passive),and the booster ejection fraction of left atrium(LAEF Booster)can be calculated.CVI42 strain module was used to measure the left ventricular strain of the three groups of subjects.After the left ventricular inner and outer membrane was delineated on short-axis,long-axis two-chamber and long-axis four-chamber cine sequence,the left ventricular global peak longitudinal strain(GPLS)and strain rate(GPLSR),the left ventricular global peak circumferential strain(GPCS)and strain rate(GPCSR),he left ventricular global peak radical strain(GPRS)and strain rate(GPRSR)can be obtained.The strain rate can be further divided into systolic global peak strain rate(s GPSR)and early diastolic global peak strain rate(e GPSR).CVI42 strain module was used to measure the left atrial strain of the three groups of subjects.After delineating the inner and outer membrane of the left atrium on long-axis two-chamber and long-axis four-chamber cine sequences,the left atrial reservoir strain(εs)and strain rate(SRs),the left atrial conduit strain(εe)and strain rate(SRe),the left atrial boost pump strain(εa)and strain rate(SRa)can be obtained.The differences in cardiac function and strain parameters among the three groups were compared and the correlation between left atrial and left ventricular strain parameters and LAEF,LVEF,and NT-pro BNP was analyzed.Receiver operating characteristic(ROC)curve was drawn and the area under ROC curve(AUC)was calculated to determine the optimal strain parameters for identifying HFpEF-HHD.Results:Comparing cardiac function and strain parameters among the three groups,it was found that LAEF Total,LAEF passive,LAEF Booster,εs,εs,SRs,SRe and SRa were significantly impaired and GPLS,GPCS,s GPLSR,e GPLSR were impaired in HFpEFHHD group.Compared with the HHD group,there were significant differences in LAEF Total,LAEF Booster,εs,εe,SRs,SRe,SRa,GPLS and s GPLSR in the HFpEF-HHD group(p<0.05).Compared with the healthy control group,there were significant differences in LAEF Total,LAEF Passive,LAEF Booster,εs,εe,SRs,SRe,SRa,GPLS,GPCS,s GPLSR and e GPLSR in the HFpEF-HHD group(p<0.05).By analyzing the correlation between left atrial and left ventricular strain parameters and LAEF,LVEF and NT-probnp in the three groups,It was found that εs was positively correlated with LAEF Total,LAEF Passive,LAEF Booster and LVEF(p<0.05),among which εs had the strongest correlation with LAEF Total(R=0.653,p<0.05),and the weakest correlation with LVEF(R=0.237,P<0.05).εe was positively correlated with LAEF Total,LAEF Passive and LAEF Booster(p<0.05),and εe had the strongest correlation with LAEF Passive(R=0.625,p<0.05).There was a moderate positive correlation between εa and LAEF Total and LAEF Booster(p<0.05),and a weak positive correlation between εa and LVEF(R=0.380,p<0.05).GPCS was weakly negatively correlated with LAEF Passive(R=-0.249,p<0.05),GPLS was moderately or weakly negatively correlated with LAEF Total,LAEF Passive,LAEF Booster and LVEF(p<0.05).There was no correlation between strain parameters and NT-pro BNP.ROC curve showed that the left atrial function parameters EF Total(AUC=0.800),EF Booster(AUC=0.767),EF Total + EF Booster(AUC=0.802),left atrial strain parameters εs(AUC=0.800),εe(AUC=0.800),SRs(AUC=0.747),SRe(AUC=0.781),SRa(AUC= 0.771),εs+εe(AUC=0.825),left ventricular strain parameters GPLS(AUC= 0.708)and s GPLSR(AUC= 0.708)all had good diagnostic value in differentiating HFpEF-HHD group and HHD group.The combination of εs and εe had the highest diagnostic efficiency.Among the single parameters,εe had the highest diagnostic efficiency.ROC curve showed that the left atrial function parameters EF Total(AUC=0.737),EF Passive(AUC=0.891),EF Booster(AUC=0.598),left atria strain parameters εs(AUC=0.770),εe(AUC=0.849),SRs(AUC=0.739),SRe(AUC=0.869),SRa(AUC= 0.688),left ventricular strain parameters GPLS(AUC=0.681),GPCS(AUC= 0.634),s GPLSR(AUC= 0.693),e GPLSR(AUC= 0.629)had good diagnostic value in differentiating HHD patients(including HFpEF-HHD group and HHD group)from healthy control group.EF Passive had the highest diagnostic efficiency,followed by SRe.Conclusions:For patients with HFPEF-HHD,left atrial strain parameters,left atrial function parameters and left ventricular strain parameters GPLS and GPLSR show better diagnostic efficacy than conventional cardiac function parameters,which can detect myocardial microscopic changes at an early stage.Left atrial strain has greater potential diagnostic value,especially εe and εs are expected to be used as incremental parameters for the diagnosis of HFpEF.