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目的通过与正常对照组的对比,确定刺激回波位移编码(DENSE)电影MRI能否有助于发现和确定2型糖尿病病人的亚临床心肌收缩功能损害的表现。材料与方法获单位伦理委员会许可和受试者的知情同意后,37例无明显心脏疾患的2型糖尿病病人和23名年龄匹配的对照组参与本前瞻性研究。受试者进行二维DENSE采集的MR电影扫描。在短轴位影像中,分别测量收缩期时左心室底部、中部和心尖部的圆周收缩应变(Ecc)和半径收缩应变(Err)。在四腔心和二腔心图像上测量纵向收缩应变(Ell)。统计检测方法包括组间相关性系数及多元线性回归分析。结果 Ecc、Err与Ell在观察者内的组间相关系数值分别为0.85、0.95和0.90,而观察者间的组间相关系数值为0.79、0.91和0.80。左心室射血分数位于参考值范围内,组间无明显差异。糖尿病病人较对照组的Ecc(-14.4%±1.6%与-17.0%±1.6%,P<0.001)、Err(36.2%±10.9%与44.4%±9.9%,P=0.006)和Ell(-12.9%±2.1%与-15.5%±1.6%,P<0.001)均减低。最后,糖尿病组在控制年龄、性别、高血压、体质量指数和左心室容量因素后,与Ecc(P<0.001)、Err(P=0.05)和Ell(P=0.01)间存在相关性。结论电影DENSE这种运动编码MRI技术,具有较高的空间分辨力,可用于心肌收缩应变能力的评价,有助于显示糖尿病病人亚临床期心脏收缩能力损害。
Objective To determine whether MRI stimulated Echocardiography can help identify and identify subclinical myocardial contractile dysfunction in patients with type 2 diabetes mellitus compared with normal controls. Materials and Methods 37 patients with type 2 diabetes mellitus without obvious heart disease and 23 age-matched controls participated in this prospective study after obtaining approval from the ethics committee and informed consent of the subjects. Subjects performed MR movie scans of 2D DENSE acquisition. In the short-axis images, the circumferential systolic strain (Ecc) and radius systolic strain (Err) of the left ventricular bottom, middle and apex were measured during systole. Longitudinal contraction strain (Ell) was measured on four-chamber and two-chamber images. Statistical test methods include correlation coefficient between groups and multivariate linear regression analysis. Results The correlation coefficients between the groups of Ecc, Err and Ell in the observer were 0.85, 0.95 and 0.90, respectively, while those between the observers were 0.79, 0.91 and 0.80. Left ventricular ejection fraction in the reference range, no significant differences between groups. Ecc (-14.4% ± 1.6% vs. -17.0% ± 1.6%, P <0.001), Err (36.2% ± 10.9% vs. 44.4% ± 9.9%, P = 0.006) and Ell (-12.9 % ± 2.1% vs -15.5% ± 1.6%, P <0.001). Finally, there were correlations between Ecc (P <0.001), Err (P = 0.05) and Ell (P = 0.01) after controlling for age, gender, hypertension, body mass index and left ventricular volume in the diabetic group. Conclusion DENSE, a motion-coded MRI technique, has high spatial resolution and can be used to evaluate myocardial systolic and diastolic function. It can help demonstrate the impairment of subclinical cardiac contractility in diabetic patients.