Quantitative Assessment Of Hypertensive Heart Disease With Dual-source CT Delayed Enhancement Scanning Study Of Early Myocardial Fibrosis

Objective: To explore the feasibility and accuracy of dual-source CT(DSCT)delayed enhancement scanning technique for quantitative evaluation of early myocardial fibrosis(MF)in hypertensive heart disease(HHD).Methods: Part 1 of this study firstly included 20 patients with hypertensive heart disease diagnosed by clinical and echocardiography from 09/2021 to 07/2022 in our hospital and 24 healthy controls using retrospective analysis.Both groups were operated with echocardiography,dual-source CT delayed enhancement scanning technique and myocardial fibrosis imaging parameters extracellular volume ECV values were calculated using the dual-source CT-ECV formula.The 44 subjects were divided into two groups(24 healthy controls and 20 patients with hypertensive heart disease)and the general clinical data of the two groups were analysed.The independent samples t-test compared the echocardiographic parameters and extracellular volume ECV values between the two groups and the final ROC curve assessed the value of the combination of echocardiographic related parameters and extracellular volume ECV values for the diagnosis of hypertensive heart disease.In part 2,44 subjects were divided into three groups(24 healthy controls,13 patients with pure hypertensive heart disease and 7patients with hypertensive heart disease with left ventricular hypertrophy with heart failure)and the general baseline characteristics of the three groups were analysed.The correlation between overall myocardial ECV values and basic clinical information was analyzed,and finally the value of dual-source CT delayed enhancement scans for quantitative assessment of early myocardial fibrosis in hypertensive heart disease was combined with ROC curves.Results: Part 1 Comparison of general clinical data between the two groups: only systolic blood pressure was higher in the case group than in the control group,with a statistically significant difference(P < 0.001).Logistic regression analysis showed that Only systolic blood pressure was an independent factor in the development of hypertensive heart disease(P < 0.05).The results of the combined diagnostic value of echocardiographic parameters and ECV showed that the area under the curve(AUC)for each parameter and ECV combination was 0.915,which had a high diagnostic performance with an optimal sensitivity and specificity of 90.00% and 83.30%,respectively.Part 2 All clinical parameters in the healthy control group were lower than those in the hypertensive heart disease alone group and the hypertensive heart disease left ventricular hypertrophy with heart failure group,with body mass index(BMI),systolic blood pressure(SBP)and ejection fraction(EF)being statistically significant between the three groups(P < 0.05).BNP)was 19.71±17.97 pg/ml significantly higher than the other two groups,but was not statistically significant between the other two groups(P>0.05).Compared to the healthy control group,the groups with hypertensive heart disease alone and hypertensive heart disease with left ventricular hypertrophy with heart failure showed significantly higher ECV values(P < 0.05),with a significant difference in ECV between the healthy control group and the hypertensive heart disease alone group(Z =-2.406;P < 0.05)and between the healthy control group and the hypertensive heart disease with left ventricular There was a significant difference in ECV between the healthy control group and the hypertensive heart disease group(Z=-2.179;P<0.05),and no correlation in ECV between the hypertensive heart disease group and the hypertensive heart disease group(Z=-0.239;P>0.05).Based on healthy controls,the best sensitivity and specificity of dual-source CT-ECV for predicting LV hypertrophy with heart failure in pure hypertensive heart disease and hypertensive heart disease based on ROC curve and Youden index analysis were 84.6%,66.7%;71.4%,70.8%,respectively,and the area under the curve(AUC)for this criterion was The correlations between ECV and basic clinical parameters indicated significant correlations between ECV and systolic blood pressure,ejection fraction,posterior left ventricular wall thickness,left ventricular end-diastolic internal diameter,and septal thickness(p < 0.05);ECV and age,body mass index(BMI),systolic blood pressure(No correlation was found between ECV and age,body mass index(BMI),systolic blood pressure(BNP)and relative ventricular wall thickness.Conclusion: Dual-source CT delayed enhancement scanning may be one of the imaging techniques for quantitative assessment of early myocardial fibrosis in hypertensive heart disease,and the combination of echocardiographic left ventricular correlation parameters with dual-source CT-ECV values has a high diagnostic performance in the diagnosis of hypertensive heart disease.