【摘要】 目的 通过运用磁共振特征追踪技术（CMR-FT）对心肌炎及健康志愿者进行心肌应变定量分析，对比分析二者之间的差异，探讨其与心功能之间的相关性，进一步探究该技术在心肌炎的应用价值。方法选取2019年8月至2020年12月在本院行心脏磁共振并诊断为心肌炎的患者14例，同时段9名为健康对照组，在CVI42后处理软件得到心功能参数及心肌应变参数，通过SPSS 20.0软件进行数据分析，比较2组间各指标差异，选取有意义参数绘制受试者特征曲线（ROC），确定截断值；对左室射血分数（LVEF）与心肌应变参数进行Pearson相关分析。结果 14例心肌炎患者共224个心脏节段，9名对照组共144个心脏节段。2组资料经处理后得到经体表面积（BSA）标化后心功能参数，其中在左室每搏排出量（LVSV）、LVEF上心肌炎组均低于对照组，且二者差别有统计学意义（P<0.05）。心肌炎组的节段峰值径向应变（PRS）、节段峰值环向应变（PCS）、节段峰值纵向应变（PLS）均低于健康对照组（P值分别为0.204、0.010、0.112）。绘制应变参数及心功能参数对心肌炎或健康志愿者的ROC曲线，发现PCS能有效诊断心肌炎，其曲线下面积（AUC）最大，达0.838(P=0.011)，灵敏度为90.9%，特异度66.7%。心功能参数中LVSV及LVEF能有效诊断健康志愿者，LVEF的AUC为0.754(P=0.044)，灵敏度为77.8%，特异度为64.3%;LVSV的AUC为0.774(P=0.030)，灵敏度为88.9%，特异度为71.4%。对LVEF与心肌应变参数进行Pearson相关性分析，LVEF与GCS呈强负相关（r=-0.85,P<0.001）,LVEF与整体环向应变（GRS）无相关（r=0.37,P=0.081）,LVEF与整体纵向应变（GLS）呈中等相关（r=-0.66,P=0.001）。心肌炎组中射血分数（EF）减低型在PRS、PCS及PLS均较EF保留型减低，其中PCS及PLS的差异有统计学意义（P<0.001）,PRS差异无统计学意义（P>0.05）。对比EF保留组及对照组，EF保留组的PRS、PCS及PLS均较对照组减低，且PCS差异具统计学意义（P=0.029）,PRS、PLS差异不具统计学意义（P=0.220、0.798）。结论 心肌应变能通过CMR-FT实现，心肌炎患者的径向应变（RS）、环向应变（CS）、纵向应变（LS）均减低，以CS减低更具特征性，CMR-FT技术有非常广阔的应用前景。更多还原

【Abstract】 Objective To carry out quantitative analysis of myocardial strain in myocarditis and healthy volunteers,compare the differences and find the correlation between the two teams, using cardiac magnetic resonance feature tracking technology(CMR-FT). So as to further explore the application value of this technology in myocarditis.Methods Fourteen patients with myocarditis and 9 healthy volunteers underwent cardiac MR feature tracking imaging in August 2019 to December 2020 in our hospital.Cardiac function and myocardial strain parameters were calculated by CVI42 software and compare the difference between the two groups by SPSS 20.0 software, then meaningful parameters were selected to draw receiver operating characteristic curve(ROC), determine the cutoff value.The pearson correlation analysis was performed between left ventricular ejection fraction(LVEF) and myocardial strain parameters. Results A total of 224 heart segments were found in 14 patients with myocarditis and 144 heart segments in 9 controls. All data standardized by the body surface area(BSA). Left ventricular cardiac output(LVSV),LVEF in myocarditis group were lower than those in the control group, and the difference had statistical significance(P<0.05). Compared with the controls, strain indices were all significantly impaired in acute stage(P and=0.204, 0.010,0.112) ROC curve of different parameters about strain and cardiac function was drowed and we found that PCS was effectively in the diagnosis of myocarditis, the AUC was 0.838(P=0.011), the sensitivity was 90.9%, 66.7%, and other strain parameters had no obvious statistical significance(P>0.05). Among cardiac function parameters, LVSV and LVEF could effectively diagnose in healthy volunteers. The AUC of LVEF was 0.754(P=0.044), The sensitivity was77.8%, and the specificity was 64.3%. The AUC of LVSV was 0.774(P=0.030), the sensitivity was 88.9% and the specificity was 71.4%. The Pearson correlation analysis of LVEF and cardiac strain parameters showed that LVEF was strongly negatively correlated with GCS(r=-0.85, P<0.001), nocorrelated with PRS(r=0.37, P=0.081), moderate correlated with GLS(r=-0.66, P=0.001). In the myocarditis group, PCS, PLS of the EF non-reserved type were lower than the EF reserved type, and the difference of them were statistically significant( P<0.001). PRS, PCS and PLS in the EF reserved group were lower than those in the control group, and the difference in PCS was statistically significant(P=0.029), while the difference in PRS and PLS was not statistically significant(P=0.220, 0.798). Conclusion The myocardial strain can be achieved through CMR-FT, and the RS,CS, LS of myocarmatitis is reduced, and the reduction of CS is more characteristic and the CMR-FT has a very broad application prospect.更多还原