摘要
目的探讨肥厚型心肌病(HCM)类缺血样强化方式的发生率、MRI影像特征及临床价值。方法回顾性分析2009年10月至2013年12月在我院经心脏磁共振(CMR)确诊为HCM患者1411例,明确有延迟强化的患者465例,其中类缺血样强化(以心内膜下强化为突出改变)24例。CMR图像经后处理分析,计算左心室射血分数(LVEF)和心内膜下钆对比剂的延迟强化(LGE)体积分数,按照美国心脏学会(AHA)17节段划分,统计心脏强化的节段分布情况。搜集其门诊及住院临床资料,并对这些患者进行门诊或电话随访。主要不良心血管事件(MACE)包括恶性室性心律失常及心力衰竭。采用Pearson相关性分析评价LVEF与心内膜下LGE体积分数的相关性,独立样本t检验比较左心室流出道梗阻组与非梗阻组的心内膜下延迟强化体积分数,Kaplan-Meier生存曲线比较类缺血样强化组与其他形式强化组的预后。结果类缺血样强化患者的发生率为0.05%(24/465)。流出道梗阻患者10例,非梗阻患者14例。患者平均LVEF值为(56.20±3.60)%,心内膜下平均LGE体积分数为(14.52±12.73)%。类缺血样强化最常见于14节段(各10例),其次依次是9、15(各8例)和3、8、16节段(各7例),这些节段主要分布于左心室室间隔及心尖部。LVEF值与心内膜下LGE体积分数呈负相关(r=-0.85,P<0.05)。梗阻患者心内膜下LGE体积分数(6.81±3.35)%低于非梗阻患者(21.55±13.52)%,差异具有统计学意义(t=-3.91,P=0.01)。所有延迟强化HCM患者的平均随访时间为(4.25±1.35)年,类缺血样强化患者的无事件生存率明显低于其余强化HCM患者(P<0.001)。结论类缺血样强化是HCM的特殊强化类型,其预后较其他延迟强化患者差,类缺血样延迟强化量与LVEF值和左心室流出道梗阻相关。
Objective To explore the prevalence, MRI characteristics and clinical evaluation of hypertrophic cardiomyopathy(HCM) patients with infarct-like late enhancement(LGE). Methods HCM patients were diagnosed via cardiac magnetic resonance(CMR) from October, 2009 to December, 2013. 1 411 HCM patients were diagnosed via CMR, 465 patients with LGE, of which 24 patients with infarct-like LGE (primarily in the subendocardium). Clinical and MRI data of patients demonstrating infarct-like LGE were retrospectively analyzed. All the HCM patients with LGE were followed up in the clinic or by telephone interview. Major adverse cardiovascular events(MACE) were defined as malignant ventricular arrhythmia events, including sudden cardiac death, ventricular tachycardia/fibrillation, implantable cardioverter defibrillator(ICD) discharge and heart failure events, including death from heart failure, heart transplantation. The correlation between left ventricle ejection fraction and subendocardial LGE volume fraction was evaluated by Pearson correlation analysis. Comparison of subendocardial LGE volume fraction between obstructed and non-obstructed left ventricular outflow tract (LVOT) group was performed using independent sample t test. Prognosis of patients with infarct-like LGE and other LGE patterns was compared using Kaplan-Meier curves. Results The prevalence of infarct-like LGE were 0.05%(24/465) among patients with LGE. Mean left venricle ejection fraction(LVEF) was (56.20±3.60)% and mean LGE volume fraction was (14.52±12.73) %. According to the American Heart Association (AHA) 17-segment model, infarct-like LGE was most frequent in 14 segment (10 patients) , followed by 9, 15 (8 patients, respectively) and 3, 8, 16 (7 patients, respectively) segments, mainly distributed in left ventricular septum and apical portion. EF value was inversely correlated with mean LGE volume fraction(r=-0.85, P<0.05).Mean follow up time was (4.25±1.35) years for all the HCM patients with LGE, and event-free survival rate was lower in HCM patients
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2018年第12期903-907,共5页
Chinese Journal of Radiology
基金
国家自然科学基金(81620108015)
首都临床特色应用研究项目基金(Z161100000516110).
关键词
心肌病
肥厚性
磁共振成像
延迟强化
Cardiomyopathy, hypertrophic
Magnetic resonance imaging
Late enhancement
