多模态影像评估左心房逆重构的研究进展Research progress in the evaluation of left atrial reverse remodeling by multimodal imaging
张敏,刘蓉,李骞
摘要(Abstract):
左心房扩大及功能受损是预测不良心血管结局的重要影像学标志物,尤其在心房颤动和左心室舒张功能障碍患者中更为显著。左心房逆重构(LARR)是通过治疗干预或自发恢复左心房的大小、形态及功能的过程,准确评估LARR对于改善心血管病患者的临床预后至关重要。超声心动图、心脏磁共振成像和核医学成像等影像技术是评估左心房结构和功能的关键工具,各类成像技术从多个角度、不同病理状态下对左心房的解剖结构进行评估,量化其功能参数,在监测病情、评估治疗效果以及预测疾病预后方面具有重要价值。本文旨在总结多模态影像在LARR评估中的最新研究进展,探讨其在临床实践中的应用前景与挑战。
关键词(KeyWords): 左心房逆重构;左心房;超声心动图;磁共振成像;核医学成像;预后
基金项目(Foundation): 湖北省宜昌市医疗卫生科研资助项目(A20-2-006);; 北京科创医学发展基金会基金项目(KC2023-JX-0186-PQ013)
作者(Author): 张敏,刘蓉,李骞
参考文献(References):
- [1]Larsen BS,Biering-S?rensen T,Olsen FJ.Ischemic stroke and the emerging role of left atrial function[J].Expert Rev Cardiovasc Ther,2024,22(7):289-300.DOI:10.1080/14779072.2024.2370814.
- [2] Sajeev JK,Kalman JM,Dewey H,et al.The atrium and embolic stroke:myopathy not atrial fibrillation as the requisite determinant?[J].JACC Clin Electrophysiol,2020,6(3):251-261.DOI:10.1016/j.jacep.2019.12.013.
- [3]Thomas L,Abhayaratna WP.Left atrial reverse remodeling:mechanisms,evaluation,and clinical significance[J].JACC Cardiovasc Imaging,2017,10(1):65-77.DOI:10.1016/j.jcmg.2016.11.003.
- [4]Xing Y,Zhang Y,Zhao R,et al.Changes of left atrial morphology and function evaluated with four-dimensional automated left atrial quantification echocardiography in patients with coronary slow flow phenomenon and preserved left ventricular ejection fraction[J].Int J Cardiol,2023,393:131351.DOI:10.1016/j.ijcard.2023.131351.
- [5]Wang Y,Bai D,Lu X,et al.Application value of real-time 3D speckle tracking imaging in left atrial function evaluation of patients with paroxysmal atrial fibrillation[J].Medicine(Baltimore),2024,103(21):e38206.DOI:10.1097/md.000000000003 8206.
- [6]刘梦梦,李莉锦,李鹏歌,等.力量型运动员左心房前后径与四维自动左心房定量功能参数的相关性[J].中国医学影像学杂志,2023,31(7):701-705,733.DOI:10.3969/j.issn.1005-5185.2023.07.005.
- [7]Kawel-Boehm N,Hetzel SJ,Ambale-Venkatesh B,et al.Reference ranges("normal values")for cardiovascular magnetic resonance(CMR)in adults and children:2020 update[J].J Cardiovasc Magn Reson,2020,22(1):87.DOI:10.1186/s12968-020-00683-3.
- [8]Cau R,Bassareo P,Suri JS,et al.The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings:an up-to-date review[J].Eur Radiol,2022,32(7):4384-4394.DOI:10.1007/s00330-022-08598-6.
- [9]Yang Y,Yin G,Jiang Y,et al.Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging:a feasibility and reproducibility study[J].J Cardiovasc Magn Reson,2020,22(1):1.DOI:10.1186/s12968-019-0589-5.
- [10]Giammarile F,Delgado Bolton RC,El-Haj N,et al.Changes in the global impact of COVID-19 on nuclear medicine departments during 2020:an international follow-up survey[J].Eur J Nucl Med Mol Imaging,2021,48(13):4318-4330.DOI:10.1007/s00259-021-05444-7.
- [11]杨婧,张孝鸿,尤玲,等.经皮左心耳封堵联合射频消融对持续性心房颤动患者的有效性和安全性及消融复发率的影响[J].中国介入心脏病学杂志,2023,31(5):321-327.DOI:10.3969/j.issn.1004-8812.2023.05.001.
- [12]Nuzzi V,Raafs A,Manca P,et al.Left atrial reverse remodeling in dilated cardiomyopathy[J].J Am Soc Echocardiogr,2023,36(2):154-162.DOI:10.1016/j.echo.2022.10.017.
- [13]Aimo A,Vergaro G,González A,et al.Cardiac remodelling-Part 2:Clinical,imaging and laboratory findings.A review from the Study Group on Biomarkers of the Heart Failure Association of theEuropean Society of Cardiology[J].Eur J Heart Fail,2022,24(6):944-958.DOI:10.1002/ejhf.2522.
- [14]Yakabe D,Ohtani K,Fukuyama Y,et al.Prognostic value of left atrial calcification after catheter ablation for atrial fibrillation[J].JACC Clin Electrophysiol,2023,9(7 Pt 2):1108-1117.DOI:10.1016/j.jacep.2022.11.016.
- [15]Agrawal V,Manouchehri A,Vaitinadin NS,et al.Identification of clinical drivers of left atrial enlargement through genomics of left atrial size[J].Circ Heart Fail,2024,17(1):e010557.DOI:10.1161/circheartfailure.123.0105 57.
- [16]白瑾,谢鹏昕,李延广,等.一项前瞻性队列研究:心房颤动射频消融治疗术后出现不良结局的风险因素[J].中国介入心脏病学杂志,2025,33(3):121-127.DOI:10.3969/j.issn.1004-8812.2025,03.001.
- [17]Sieweke JT,Hagemus J,Biber S,et al.Echocardiographic parameters to predict atrial fibrillation in clinical routine-the eahsy-AF risk score[J].Front Cardiovasc Med,2022,9:851474.DOI:10.3389/fcvm.2022.851474.
- [18]Habibi M,Zareian M,Ambale Venkatesh B,et al.Left atrial mechanical function and incident ischemic cerebrovascular events independent of AF:insights from the MESA study[J].JACC Cardiovasc Imaging,2019,12(12):2417-2427.DOI:10.1016/j.jcmg.2019.02.021.
- [19]Aronsen JM,Swift F,Sejersted OM.Cardiac sodium transport and excitation-contraction coupling[J].J Mol Cell Cardiol,2013,61:11-19.DOI:10.1016/j.yjmcc.2013.06.003.
- [20]Drakos SG,Badolia R,Makaju A,et al.Distinct transcriptomic and proteomic profile specifies patients who have heart failure with potential of myocardial recovery on mechanical unloading and circulatory support[J].Circulation,2023,147(5):409-424.DOI:10.1161/circulationaha.121.056600.
- [21]Aboumsallem JP,Muthuramu I,Mishra M,et al.Effective treatment of diabetic cardiomyopathy and heart failure with reconstituted HDL(Milano)in mice[J].Int J Mol Sci,2019,20(6):1273.DOI:10.3390/ijms20061273.
- [22] Rettmann ME,Holmes DR 3rd,Monahan KH,et al.Treatmentrelated changes in left atrial structure in atrial fibrillation:findings from the CABANA imaging sub study[J].Circ Arrhythm Electrophysiol,2021,14(5):e008540.DOI:10.1161/CIRCEP.120.008540.
- [23]Boyd AC,Richards DA,Marwick T,et al.Atrial strain rate is a sensitive measure of alterations in atrial phasic function in healthy ageing[J].Heart,2011,97(18):1513-1519.DOI:10.1136/heartjnl-2011-300134.
- [24]Khidr S,Doyle M,Rayarao G,et al.Pulmonary vein remodeling following pulmonary vein isolation in patients with atrial fibrillation-do pulmonary veins represent only an epiphenomenon?A cardiac MRI study[J].Cardiovasc Diagn Ther,2019,9(1):8-17.DOI:10.21037/cdt.2018.09.07.
- [25]Lang RM,Badano LP,Mor-Avi V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.e14.DOI:10.1016/j.echo.2014.10.003.
- [26]Khan MA,Yang EY,Zhan Y,et al.Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance:a multicenter study[J].J Cardiovasc Magn Reson,2019,21(1):4.DOI:10.1186/s12968-018-0517-0.
- [27]Sun Y,Chen X,Zhang Y,et al.Reverse atrial remodelingin heart failure with recovered ejection fraction[J].J Am Heart Assoc,2023,12(2):e026891.DOI:10.1161/JAHA.122.026891.
- [28]Thadani SR,Shaw RE,Fang Q,et al.Left atrial end-diastolic volume index as a predictor of cardiovascular outcomes:the heart and soul study[J].Circ Cardiovasc Imaging,2020,13(4):e009746.DOI:10.1161/circimaging.119.009746.
- [29]张新娜,侯唯姝,俞宏林,等.心脏磁共振在左心房评估中的应用[J].中国医学影像学杂志,2024,32(1):100-104.DOI:10.3969/j.issn.1005-5185.2024.01.017.
- [30]Soulat-Dufour L,Lang S,Addetia K,et al.Restoring sinus rhythm reverses cardiac remodeling and reduces valvular regurgitation in patients with atrial fibrillation[J].J Am Coll Cardiol,2022,79(10):951-961.DOI:10.1016/j.jacc.2021.12.029.
- [31] Gan GCH,Bhat A,Chen HHL,et al.Determinants of LA reservoir strain:independent effects of LA volume and LV global longitudinal strain[J].Echocardiography,2020,37(12):2018-2028.DOI:10.1111/echo.14922.
- [32]Takagi T,Hosomi T.Peak atrial longitudinal strain represents atrial fibrillation burden in daily practice:clinical implication of routine left atrial strain measurements[J].J Echocardiogr.,2023,21(3):113-121.DOI:10.1007/s12574-022-00595-4.
- [33]Laish-Farkash A,Perelshtein Brezinov O,Valdman A,et al.Evaluation of left atrial remodeling by 2D-speckletracking echocardiography versus by high-density voltage mapping in patients with atrial fibrillation[J].J Cardiovasc Electrophysiol,2021,32(2):305-315.DOI:10.1111/jce.14837.
- [34]Avesani M,Sabatino J,Borrelli N,et al.The mechanics of congenital heart disease:from a morphological trait to the functional echocardiographic evaluation[J].Front Cardiovasc Med,2024,11:1301116.DOI:10.3389/fcvm.2024.1301116.
- [35]Stassen J,Galloo X,Chimed S,et al.Clinical implications of left atrial reverse remodelling after cardiac re synchronization therapy[J].Eur Heart J Cardiovasc Imaging,2022,23(6):730-740.DOI:10.1093/ehjci/jeac042.
- [36]Yoon SJ,Park S,Choi EY,et al.Left atrial velocity vector imaging can assess early diastolic dysfunction in left ventricular hypertrophy and hypertrophic cardiomyopathy[J].J Cardiovasc Imaging,2023,31(1):41-48.DOI:10.4250/jcvi.2022.0064.
- [37]Müller P,Weij s B,Bemelmans NMAA,et al.Echocardiography-derived total atrial conduction time(PA-TDI duration):risk stratification and guidance in atrial fibrillation management[J].Clin Res Cardiol,2021,110(11):1734-1742.DOI:10.1007/s00392-021-01917-9.
- [38]Angelini E,Sieweke JT,Berliner D,et al.Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation[J].Front Cardiovasc Med,2023,10:1270422.DOI:10.3389/fcvm.2023.1270422.
- [39]Peters DC,Lamy J,Sinusas AJ,et al.Left atrial evaluation by cardiovascular magnetic resonance:sensitive and unique biomarkers[J].Eur Heart J Cardiovasc Imaging,2021,23(1):14-30.DOI:10.1093/ehjci/jeab221.
- [40]王灵丽,冯馨仪,张天悦,等.基于心脏磁共振的左心房应变在心脏疾病中的应用进展[J].磁共振成像,2023,14(3):179-183.DOI:10.12015/issn.1674-8034.2023.03.033.
- [41]Yang S,Chen X,Zhao K,et al.Reverse remodeling of left atrium assessed by cardiovascular magnetic resonance feature tracking in hypertrophic obstructive cardiomyopathy after septalmyectomy[J].J Cardiovasc Magn Reson,2023,25(1):13.DOI:10.1186/s12968-023-00915-2.
- [42]Quail M,Grunseich K,B aldas sarre LA,et al.P rognostic and functional implications of left atrial late gadolinium enhancement cardiovascular magnetic resonance[J].J Cardiovasc Magn Reson,2019,21(1):2.DOI:10.1186/s12968-018-0514-3.
- [43]Habibi M,Lima JAC,Gucuk Ipek E,et al.Short-and long-term associations of atrial fibrillation catheter ablation with left atrial structure and function:a cardiac magnetic resonance study[J].J Cardiovasc Electrophysiol,2021,32(2):316-324.DOI:10.1111/jce.14842.
- [44]贾溪,赵世华.2023年SCMR 4D Flow心血管磁共振共识声明解读[J].磁共振成像,2024,15(3):1-6.DOI:10.12015/issn.1674-8034.2024.03.001.
- [45]Sugumar H,Prabhu S,Voskoboinik A,et al.Atrial remodeling following catheter ablation for atrial fibrillationmediated cardiomyopathy:long-term follow-up of CAMERAMRI study[J].JACC Clin Electrophysiol,2019,5(6):681-688.DOI:10.1016/j.jacep.2019.03.009.
- [46]Kazimierczyk R,Kaminski KA,Nekolla SG.Cardiac PET/MRI:recent developments and future aspects[J].Semin Nucl Med,2024,54(5):733-746.DOI:10.1053/j.semnuclmed.2024.05.007.
- [47]Stirrup J,Gregg S,Baavour R,et al.Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi:technique and validation in patients with atrial fibrillation[J].J Nucl Cardiol,2020,27(6):1939-1950.DOI:10.1007/s12350-018-01535-5.
- [48]Romanov A,Minin S,Nikitin N,et al.The relationship between global cardiac and regional left atrial sympathetic innervation and epicardial fat in patients with atrial fibrillation[J].Ann Nucl Med,2021,35(10):1079-1088.DOI:10.1007/s12149-021-01643-2.
- [49]Kupusovic J,Weber M,Bruns F,et al.PET/CT-identified atrial hypermetabolism is an index of atrial inflammation in patients with atrial fibrillation[J].J Nucl Cardiol,2023,30(5):1761-1772.DOI:10.1007/s 12350-023-03248-w.
- [50]Barton AK,Tzolos E,Bing R,et al.Emerging molecular imaging targets and tools for myocardial fibrosis detection[J].Eur Heart J Cardiovasc Imaging,2023,24(3):261-275.DOI:10.1093/ehjci/jeac242.
- [51]Wang J,Ma X,Zhao K,et al.Association between left atrial myopathy and sarcomere mutation in patients with hypertrophic cardiomyopathy:insights into left atrial strain by MRI feature tracking[J].Eur Radiol,2024,34(2):1026-1036.DOI:10.1007/s00330-023-10128-x.
- [52]Lacaita PG,Beyer C,Plank F,et al.Late enhancement computed tomography for left atrial fibrosis imaging:a pilot"Proof-of-Concept"study[J].Diagnostics(Basel),2024,14(23):2753.DOI:10.3390/diagnostics 14232753.
- [53]Falasconi G,Penela D,Soto-Iglesias D,et al.Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation[J].Europace,2023,25(5):euad118.DOI:10.1093/europace/euad118.
- [54]Chen Q,Chen X,Wang J,et al.Redistribution of adipose tissue is associated with left atrial remodeling and dysfunction in patients with atrial fibrillation[J].Front Cardiovasc Med,2022,9:969513.DOI:10.3389/fcvm.2022.969513.
- [55]Ciuffo L,Nguyen H,Marques MD,et al.Periatrial fat quality predicts atrial fibrillation ablation outcome[J].Circ Cardiovasc Imaging,2019,12(6):e008764.DOI:10.1161/CIRCIMAGING.118.008764.
- [56]Giusca S,Korosoglou G,Montenbruck M,et al.Multiparametric early detection and prediction of cardiotoxicity using myocardial strain,T1 and T2 mapping,and biochemical markers:a longitudinal cardiac resonance imaging study during2 years of follow-up[J].Circ Cardiovasc Imaging,2021,14(6):e012459.DOI:10.1161/CIRCIMAGING.121.012459.
- [57]Zeilinger MG,Kunze KP,Munoz C,et al.Non-rigid motioncorrected free-breathing 3D myocardial Dixon LGE imaging in a clinical setting[J].Eur Radiol,2022,32(7):4340-4351.DOI:10.1007/s00330-022-08560-6.
- [58]Chen HH,Liu CM,Chang SL,et al.Automated extraction of left atrial volumes from two-dimensional computer tomography images using a deep learning technique[J].Int J Cardiol,2020,316:272-278.DOI:10.1016/j.ijcard.2020.03.075.
- [59]Zheng D,Zhang Y,Huang D,et al.Incremental predictive utility of a radiomics signature in a nomogram for the recurrence of atrial fibrillation[J].Front Cardiovasc Med,2023,10:1203009.DOI:10.3389/fcvm.2023.1203009.
- [60]Jaltotage B,Lu J,Dwivedi G.Use of artificial intelligence including multimodal systems to improve the management of cardiovascular disease[J].Can J Cardiol,2024,40(10):1804-1812.DOI:10.1016/j.cjca.2024.07.014.
- [61]Skouri H,Girerd N,Monzo L,et al.Clinical management and therapeutic optimization of patients with heart failure with reduced ejection fraction and low blood pressure.A clinical consensus statement of the Heart Failure Association(HFA)of the ESC[J].Eur J Heart Fail,2025,27(4):707-722.DOI:10.1002/ejhf.3618.