延迟增强心脏磁共振成像预测主动脉瓣病变伴巨大左心室术后不良预后  

The predictive value of DE-CMR in patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber

作　　者：林熠[1] 杨守国[1] 陈昊[1] 张红强[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《中华外科杂志》2012年第12期1087-1090,共4页Chinese Journal of Surgery

摘　　要：目的探讨负荷心肌灌注MRI及钆对比剂延迟增强心脏磁共振成像（DE—CMR）预测重度主动脉瓣关闭不全伴巨大左心室患者的手术预后的价值。方法选择2008年2月至2010年11月就诊患者中慢性主动脉瓣关闭不全伴巨大左心室、超声心动图左心室舒张末期内径〉70mm或左心室收缩末期内径〉55mm的病例，同时排除合并冠心病、二尖瓣器质性病变、既往心脏手术史的患者。根据术前负荷心肌灌注MRI是否出现延迟增强，分为延迟组和非延迟组。主要研究终点为总生存率，次要研究终点为心功能、术后住院时间等。共入组37例，其中延迟组15例，非延迟组22例；均行手术治疗，其中主动脉瓣置换术28例，Bentall术3例，Wheat术6例，11例同期行二尖瓣成形术。结果术后平均随访33．6个月，共有6例死亡，另有8例在随访过程中心功能（NYHA分级）进展为Ⅲ-Ⅳ级。1、2、3年无事件生存率延迟组为80．0％、48．9％、32．6％，非延迟组为94．7％、88．4％、72．6％（χ2=7．244，P=0．007）。术后平均住院时间延迟组（10±3）d，非延迟组（9±2）d（t=1．175，P=0．248）。结论DE—CMR存在延迟增强可能预示慢性重度主动脉瓣关闭不全伴巨大左心室患者主动脉瓣置换手术的不良预后。对于这些患者，需在术前评估并指导危险分层，以预防心力衰竭和猝死。Objective To determine whether preoperative contrast delay-enhanced cardiovascular magnetic resonance imaging （DE-CMR） could help predict long-term survival of patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber after aortic valve replacement. Methods Totally 37 patients enrolled between February 2008 and November 2010 with severe chronic aortic regurgitation and extremely dilated left ventricular chamber, who met the echo criteria, that was left ventricular end diastolic dimension 〉 70 mm or left ventricular end systolic dimension 〉 55 mm, and were scheduled to the surgery. The 2-dimensional echocardiographic examinations and CMR with late gadolinium-enhancement （LGE） were performed routinely preoperatively. According to the results of CMR, the patients were divided into 2 groups： the LGE positive （ ＋ ） group and LGE negative （ - ） group. The association of LGE with event free survival, postoperative cardiac function and postoperative hospital stay time was investigated. Fifteen patients had significant LGE signals in CMR films, while the other twenty-two were silent. All of them received the operative procedures, including aortic valve replacement in 28 cases, Bentall procedure in 3 cases, aortic valve replacement and ascending aorta replacement in 6 cases, and concomitant mitral valve repair in 11 cases. Results Over a follow-up of 33.6 months, 1-year, 2-year and 3-year event free survival rates in LGE （ - ） group were 94. 7% , 88.4% , and 72. 6% , respectively, compared to 80. 0%, 48. 9%, and 32. 6%, respectively in LGE （ ＋ ） group （χ2 = 7. 244, P = 0.007）. The postoperative hospital stay time of LGE （ - ） group was （9±2） days, which of LGE （ ＋ ） group was （ 10 ± 3 ） days （ t = 1. 175, P = 0. 248 ）. Conclusions LGE positive signal in CMR films is a potential predictor of persistent cardiac failure after aortic valve replacement for patients with severe chronic aortic regurgitation and extremely dilated

关 键 词：主动脉瓣关闭不全 肥大 左心室 图像增强 磁共振成像 

分 类 号：R654.2[医药卫生—外科学]