室性心律失常患者心肌瘢痕的增强磁共振研究  

Myocardial scar revealed by gadolinium enhanced cardiac magnetic resonance imaging in patients with ventricular arrhythmia

作　　者：陈玉成[1] 姜建[1] 杨庆[1] 胡宏德[1] 崔凯军[1] 孙家喻[2] 夏春潮[2] 付华[1] 

机构地区：[1]四川大学华西医院心内科,成都610041 [2]四川大学华西医院放射科,成都610041

出　　处：《中华心律失常学杂志》2014年第5期349-352,400,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金面上项目（81271531）

摘　　要：目的 评价室性心律失常患者中心肌内瘢痕或纤维化的分布特征,为室性心律失常机制研究及导管消融提供线索.方法 纳入于2012年1月至2013年5月在四川大学华西医院因各种类型的室性心律失常就诊,行心脏增强磁共振检查评估患者154例,其中室性心动过速104例,室性早搏50例.所有患者均采用3T磁共振成像系统（Trio,德国西门子公司）,采用标准化的成像方案,完成心脏的结构功能以及心肌钆延迟显像（LGE）,分析心肌LGE在室性心律失常患者中的分布特征.结果 在154例患者中,临床诊断为扩张型心肌病9例,缺血性心肌病6例,肥厚型心肌病2例,致心律失常性心肌病14例,先天性心脏病患者1例,无已知器质性疾病室性心律失常122例.LGE阳性患者在室性心律失常患者中的比例为21.4％,其中在已知的器质性心脏疾病中的比例为59.3％,在临床诊断的特发性室性心律失常的患者中分布率11.5％,在组间分布差异有统计学意义（P＜0.05）;分布特征分析,符合非缺血性心肌瘢痕分布特征（外膜或心肌中层）占81.2％;缺血性分布特征的占18.8％.结论 室性心律失常患者中心肌瘢痕发生不少见,深入了解心肌瘢痕的分布特征将有助于细致的评估室性心律失常的基质,可能为射频消融提供影像学指导.Objective We sought to investigate myocardial scar by cardiac magnetic resonance imaging （CMR） in patients with ventricular arrhythmia（VA）,and to probe the potential mechanism of VA.Methods A series of patients with VA were prospectively included.A comprehensive gadolinium enhanced CMR was performed in each case.Myocardial late gadolinium enhancement （LGE） was meticulously analyzed in each case.Results A consecutive of 154 cases with VA were recruited,which consisted of 104 VT and 50 premature ventricular contraction（PVC）.Nine cases had dilated cardiomyopathy,6 cases had ischemic heart disease,2 patients had hypertrophied cardiomyopathy,1 patient had congenital heart disease,14 cases had arrhythmogenic right ventricular dysplasia and 122 cases had no any known heart disease.The prevalence of LGE in the whole group was 21.4%.In patients with structural heart diseases,this prevalence of LGE was 59.3%,whereas in patients without structural heart diseases the prevalence was 11.5%.And 81.2% of all cases with LGE were in accordance with non-ischemic characteristic and the rest was classified with ischemic type.Conclusion Myocardial LGE was not uncommon in patients with VA.A careful evaluation by CMR will provide helpful guide for potential ablation of VA.

关 键 词：室性心律失常 磁共振成像 钆延迟显像 

分 类 号：R541.7[医药卫生—心血管疾病]