非对称性肥厚型心肌病与心尖肥厚型心肌病心脏磁共振成像特点分析  

Magnetic Resonance Imaging Characteristics of Asymmetrical Septal Hypertrophy and Apical Hypertrophic Cardiomyopathy

作　　者：马晓海[1] 赵蕾[1] 葛海龙[2] 张焕[1] 李志伟[1] 晏子旭[1] 范占明[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京市100029 [2]首都医科大学附属北京安贞医院心内科,北京市100029

出　　处：《中国全科医学》2015年第18期2166-2169,共4页Chinese General Practice

基　　金：国家自然科学基金资助项目(81101173);北京市卫生系统高层次卫生技术人才培养计划(2013-3-005)

摘　　要：目的对比非对称性肥厚型心肌病(ASH)与心尖肥厚型心肌病(APH)心肌形态功能学和延迟增强特点,评估心脏磁共振成像(CMR)检查在诊断APH中的临床价值。方法回顾性分析2013年1月—2014年12月首都医科大学附属北京安贞医院就诊的肥厚型心肌病(HCM)患者52例,ASH 40例(ASH组),APH 12例(APH组)。患者均行CMR检查,观察心肌受累节段,定量测量左心室舒张末期容积(EDV)、左心室射血分数、心肌质量、各节段舒张末期室壁厚度及延迟增强特点。结果 ASH组与APH组患者左心室射血分数比较,差异无统计学意义(P>0.05);APH组患者EDV低于ASH组,心肌质量高于ASH组(P<0.05)。ASH组患者心肌纤维化发生率〔57.5%(23/40)与41.7%(5/12)〕及纤维化心肌质量占心尖部心肌质量的比重(17.9%与10.8%)高于APH组(χ2值分别为5.070和1.976,P<0.05)。纤维化心肌质量占心尖部心肌质量的比重与心尖段室壁厚度呈正相关(r=0.780,P<0.05)。结论 CMR从形态、功能改变及延迟增强病灶特点等方面可诊断、鉴别诊断ASH及APH。ASH和APH延迟增强范围均主要位于形态改变明显区域,且延迟增强提示心肌纤维化,其对于临床治疗有一定指导意义。Objective To compare the functional parameter and late gadolinium enhancement（ LGE）character between asymmetrical septal hypertrophy（ASH）and apical hypertrophic cardiomyopathy（APH）,and to evaluate the value of cardiac magnetic resonance（CMR）in diagnosis of APH. Methods A total of 52 HCM patients who went to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2013 to December 2014,were selected as study subjects,among these cases,there were 40 cases of ASH（ ASH group） and 12 cases of APH（ APH group）,the data of cases were retrospectively reviewed. All cases underwent CMR,myocardial involvement segments were observed,EDⅤ,LⅤEF,myocardial mass,end - diastolic ventricular wall thickness of various segments,and LGE character were measured quantitatively. Results There was no significant difference in LⅤEF between ASH group and APH group（P 〉 0. 05）;EDⅤ of patients in APH group was significantly lower than that of patients in ASH group,myocardial mass of patients in APH group was significantly higher than that of patients in ASH group（P 〈 0. 05）. The incidence of myocardial fibrosis of ASH group was significantly higher than that of APH group〔57. 5% （23 / 40）vs. 41. 7% （5 / 12）,χ2 = 5. 070,P 〈 0. 05〕,and the proportion of fibrotic myocardial mass in the total myocardial mass in ASH group was significantly higher than that in APH group（17. 9% vs. 10. 8% ,χ2 = 1. 976,P 〈0. 05）. And the proportion of fibrotic myocardial mass in the total myocardial mass was positively correlated with ventricular wall thickness of apical segment（r = 0. 780,P 〈 0. 05）. Conclusion According to morphology,cardiac functional parameters and LGE character,CMR can make diagnosis and the differential diagnosis of ASH and APH. LGE lesions of ASH and APH lay mainly in area with obvious morphological change,and LGE indicates myocardial fibrosis,which provides information for clinical therapy.

关 键 词：心肌病 肥厚性 磁共振成像 每搏输出量 

分 类 号：R542.2[医药卫生—心血管疾病]