背景:慢性肾脏病(CKD)与增加,和早期心血管疾病的风险。左心室(LV)内的血液动力学的变化响应于心脏重塑。非透析CKD患者的LV血流动力学尚不清楚。
目的:使用四维血流MRI(4DflowMRI)探讨CKD患者LV动能(KE)的变化以及LVKE与LV重塑的关系。
方法:回顾性。
方法:98名透析前CKD患者(3期:n=21,4期:n=21,5期:n=56)和16名年龄和性别匹配的健康对照。
■3.0T/平衡稳态自由进动(SSFP)电影序列,具有快速场回波序列的4D流MRI,具有修改的Look-LockerSSFP序列的T1映射,和T2映射与梯度召回和自旋回波序列。
结果:人口统计学特征(年龄,性别,高度,体重,血压,心率,主动脉瓣反流,和二尖瓣返流)和实验室数据(eGFR,肌酐,血红蛋白,铁蛋白,转铁蛋白饱和度,钾,和二氧化碳结合能力)从患者记录中提取。心肌T1、T2、LV射血分数、舒张末期容积(EDV),收缩末期容积,低压流组件(直接流,延迟喷射,留存流入量和残余体积)和KE参数(收缩压峰值,收缩压,舒张压,峰值E波,峰值A波,E/A比,和全球)进行了评估。将KE参数归一化为EDV(KEiEDV)。比较CKD患者疾病分期之间的参数,CKD患者和健康对照者之间。
方法:使用单因素方差分析比较组间临床和影像学参数的差异,KruskalWalls和Mann-WhitneyU测试,卡方检验,和费希尔的精确检验。采用Pearson或Spearman相关系数和多元线性回归分析比较LVKE与其他临床和功能参数的相关性。P值<0.05被认为是显著的。
结果:与健康对照组相比,收缩压峰值(24.76±5.40μJ/mL与31.86±13.18μJ/mL),收缩压(11.62±2.29μJ/mLvs.15.27±5.10μJ/mL),舒张压(7.95±1.92μJ/mLvs.13.33±5.15μJ/mL),峰值A波(15.95±4.86μJ/mL与31.98±14.51μJ/mL),和全局KEiEDV(9.40±1.64μJ/mL与14.02±4.14μJ/mL)显着增加,KEiEDVE/A比(1.16±0.67vs.CKD患者的0.69±0.53)显着降低。随着CKD阶段的进展,两者舒张KEiEDV(10.45±4.30μJ/mLvs.12.28±4.85μJ/mLvs.14.80±5.06μJ/mL)和峰值E波KEiEDV(15.30±7.06μJ/mL与14.69±8.20μJ/mLvs.19.33±8.29μJ/mL)明显增加。在多元回归分析中,全局KEiEDV(β*=0.505;β*=0.328),和直接流量的比例(β*=-0.376;β*=-0.410)显示出与T1和T2时间的独立关联。
结论:4D流MRI衍生的LVKE参数显示CKD患者的LV适应性改变,并且与T1和T2标测独立相关,可能代表心肌纤维化和水肿。
方法:
■阶段3.
BACKGROUND: Chronic kidney disease (CKD) is associated with increased, and early cardiovascular disease risk. Changes in hemodynamics within the left ventricle (LV) respond to cardiac remodeling. The LV hemodynamics in nondialysis CKD patients are not clearly understood.
OBJECTIVE: To use four-dimensional blood flow MRI (4D flow MRI) to explore changes in LV kinetic energy (KE) and the relationship between LV KE and LV remodeling in CKD patients.
METHODS: Retrospective.
METHODS: 98 predialysis CKD patients (Stage 3: n = 21, stage 4: n = 21, and stage 5: n = 56) and 16 age- and sex-matched healthy controls.
UNASSIGNED: 3.0 T/balanced steady-state free precession (SSFP) cine sequence, 4D flow MRI with a fast field echo sequence, T1 mapping with a modified Look-Locker SSFP sequence, and T2 mapping with a gradient recalled and spin echo sequence.
RESULTS: Demographic characteristics (age, sex, height, weight, blood pressure, heart rate, aortic regurgitation, and mitral regurgitation) and laboratory data (eGFR, Creatinine, hemoglobin, ferritin, transferrin saturation, potassium, and carbon dioxide bonding capacity) were extracted from patient records. Myocardial T1, T2, LV ejection fraction, end diastolic volume (EDV), end systolic volume, LV flow components (direct flow, delayed ejection, retained inflow, and residual volume) and KE parameters (peak systolic, systolic, diastolic, peak E-wave, peak A-wave, E/A ratio, and global) were assessed. The KE parameters were normalized to EDV (KEiEDV). Parameters were compared between disease stage in CKD patients, and between CKD patients and healthy controls.
METHODS: Differences in clinical and imaging parameters between groups were compared using one-way ANOVA, Kruskal Walls and Mann-Whitney U tests, chi-square test, and Fisher\'s exact test. Pearson or Spearman\'s correlation coefficients and multiple linear regression analysis were used to compare the correlation between LV KE and other clinical and functional parameters. A P-value of <0.05 was considered significant.
RESULTS: Compared with healthy controls, peak systolic (24.76 ± 5.40 μJ/mL vs. 31.86 ± 13.18 μJ/mL), systolic (11.62 ± 2.29 μJ/mL vs. 15.27 ± 5.10 μJ/mL), diastolic (7.95 ± 1.92 μJ/mL vs. 13.33 ± 5.15 μJ/mL), peak A-wave (15.95 ± 4.86 μJ/mL vs. 31.98 ± 14.51 μJ/mL), and global KEiEDV (9.40 ± 1.64 μJ/mL vs. 14.02 ± 4.14 μJ/mL) were significantly increased and the KEiEDV E/A ratio (1.16 ± 0.67 vs. 0.69 ± 0.53) was significantly decreased in CKD patients. As the CKD stage progressed, both diastolic KEiEDV (10.45 ± 4.30 μJ/mL vs. 12.28 ± 4.85 μJ/mL vs. 14.80 ± 5.06 μJ/mL) and peak E-wave KEiEDV (15.30 ± 7.06 μJ/mL vs. 14.69 ± 8.20 μJ/mL vs. 19.33 ± 8.29 μJ/mL) increased significantly. In multiple regression analysis, global KEiEDV (β* = 0.505; β* = 0.328), and proportion of direct flow (β* = -0.376; β* = -0.410) demonstrated an independent association with T1 and T2 times.
CONCLUSIONS: 4D flow MRI-derived LV KE parameters show altered LV adaptations in CKD patients and correlate independently with T1 and T2 mapping that may represent myocardial fibrosis and edema.
METHODS: UNASSIGNED: Stage 3.