基于CMR致心律失常性右室心肌病心肌纤维化程度与心功能的相关性研究  

The Correlation Between Myocardial Fibrosis and Heart Function Based on CMR in Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy

作　　者：钟小梅[1] 罗海营[1] 刘辉[1] 黄美萍[1] 李景雷[1] 梁长虹[1] 

机构地区：[1]广东省人民医院/广东省医学科学院放射科,510080

出　　处：《临床放射学杂志》2016年第9期1362-1366,共5页Journal of Clinical Radiology

基　　金：广东省科技计划项目(编号:2011B031800045);广东省医学科研基金(编号:A2014051)

摘　　要：目的探讨致心律失常性右室发育不良/心肌病(ARVD/C)心室壁心肌纤维化程度与心室容积及心室功能变化的相关性,以期通过纤维化程度评估患者预后。方法搜集依据最新ARVD/C诊断指南确诊并行心脏磁共振(CMR)检查患者的影像学资料,定量测量心室容积和功能,包括心室舒张末容积(EDV)、心室收缩末容积(ESV)、每搏输出量(SV)、射血分数(EF)及心室舒张末容积指数(EDVI)。并分别计算左心室壁、右心室壁及总体心肌纤维化指数,评估其纤维化严重程度。分析心肌纤维化指数与心脏功能指标间的相关性。结果共35例患者确诊为ARVD/C且行CMR检查,CMR评估ARVD/C患者的LVEF为(48.39±11.10)%,LVEDVI为(111.14±28.66)m L/m^2;RVEF为(33.51±13.19)%,RVEDVI为(174.74±64.36)m L/m^2。CMR评估左心室壁心肌纤维化指数为(19.7±28.4)%,右心室壁心肌纤维化指数为(50.9±37.7)%,总体心肌纤维化指数为(26.8±28.9)%。左心室壁心肌纤维化指数与LVEF间呈负相关(r=-0.669,P<0.01),右心室壁心肌纤维化指数与RVEF间呈负相关且相关程度高(r=-0.874,P<0.01);总体心肌纤维化指数与LVEF、RVEF间亦均呈负相关,相关系数分别为-0.588(P<0.01)、-0.835(P<0.01)。右心室壁心肌纤维化指数、总体心肌纤维化指数与右心室舒张末容积指数(RVEDVI)间均呈显著正相关,相关系数分别为0.846(P<0.01)、0.847(P<0.01)。结论 CMR可以全面评价ARVD/C患者心肌组织特征变化及心脏功能改变;CMR显示的心室壁心肌纤维化程度与心功能存在相关性,可以间接反映心脏功能的变化情况。Objective To explore the correlation between the severity of myocardial fibrosis and heart function,then evaluate the prognosis of patients based on the severity of the myocardial fibrosis. Methods Clinical data of patients with ARVD / C were collected. All the patients had undergone cardiac magnetic resonance（ CMR） imaging examination. Quantitative indexes of CMR images included the ventricular end-diastole volume（ LVEDV and RVEDV）,ventricular end-systole volume（ LVESV and RVESV）,ventricular stroke volume（ LVSV and RVSV）,ventricular ejection fraction（ LVEF and RVEF） and ventricular end-diastole volume index（ LVEDVI and RVEDVI）. Late gadolinium enhancement of myocardium was evaluated. Myocardial fibrosis of the left and right ventricle was evaluated and myocardial fibrosis index was calculated.The correlation between myocardial fibrosis index and indexes of heart function was analysed. Results 35 patients with ARVD / C were enrolled. LVEF,LVEDVI,RVEF and RVEDVI were（ 48. 39 ± 11. 10） %,（ 111. 14 ± 28. 66） m L / m^2,（ 33. 51 ± 13. 19） % and（ 174. 74 ± 64. 36） m L/m^2,respectively. Myocardial fibrosis index of left ventricle and right ventricle were（ 19. 7 ± 28. 4） % and（ 50. 9 ± 37. 7） %,respectively. And total myocardial fibrosis index was（ 26. 8 ±28. 9） %. There was negative correlation between left ventricle myocardial fibrosis index with LVEF（ r =- 0. 669,P〈0. 01） and between right ventricle myocardial fibrosis index with RVEF（ r =- 0. 874,P〈0. 01）. Total myocardial fibro-sis index negatively correlated with LVEF（ r =- 0. 588,P〈0. 01） and RVEF（ r =- 0. 835,P〈0. 01）. There was positive correlation between right ventricle myocardial fibrosis index with RVEDVI（ r = 0. 846,P〈0. 01）,while total myocardial fibrosis index positively correlated with RVEDVI（ r = 0. 847,P〈0. 01）. Conclusion CMR can provide information about the morphology and histological characteristics of the heart and accurate assessment of right ventricula

关 键 词：心脏磁共振成像 致心律失常性右室发育不良/心肌病 心肌纤维化 心室功能 

分 类 号：R542.2[医药卫生—心血管疾病]