终末期肥厚型心肌病的MRI特征及预后分析  

MRI characteristics and outcomes of end-stage hypertrophic cardiomyopathy

作　　者：程赛楠 崔辰[1] 李璐[1] 尹刚[1] 陈秀玉[1] 陆敏杰[1] 赵世华[1] 

机构地区：[1]国家心血管病中心北京协和医学院,中国医学科学院阜外医院磁共振影像中心,北京100037

出　　处：《中国医学影像技术》2017年第4期539-544,共6页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(81620108015);协和青年基金(3332016025)

摘　　要：目的探讨终末期肥厚型心肌病(ES-HCM)患者MRI特征及预后。方法回顾性收集我院接受MR检查的ES-HCM患者57例,根据心肌形态结构及运动功能,分为扩张性组(D-ES,n=39)及限制性组(R-ES,n=18),比较2组患者临床、MRI特征及预后。结果 R-ES组心房颤动及下肢水肿发生率明显高于D-ES组[72.22%(13/18)vs 30.77%(12/39);50.00%(9/18)vs 23.08%(9/39);P均<0.05]。D-ES组患者左心室射血分数、左右心房前后径显著小于RES组(P均<0.05),左心室舒张末内径、左心室舒张/收缩末容积、左心室舒张/收缩末容积指数显著大于R-ES组(P均<0.05)。Log-rank检验发现2组患者发生心源性死亡/心脏移植事件的差异无统计学意义(χ~2=1.135,P=0.287)。但D-ES组对比剂延迟强化(LGE)体积分数显著高于R-ES组[(36.1±14.8)%vs(21.0±9.0)%,P<0.001],且LGE体积分数与心源性死亡/心脏移植风险相关(HR:1.054,P<0.05)。结论 ES-HCM患者MRI特征呈多样性,不仅有扩张性失代偿改变,而且有限制性失代偿改变。MRI在该病的诊断和预后评估中有重要价值。Objective To clarify the MRI characteristics and outcomes of patients with end-stage hypertrophic cardiomyopathy （ES-HCM）. Methods Clinical and MRI data of 57 ES-HCM patients were retrospectively analyzed. ES-HCM patients were divided into dilated phenotype group （D-ES group, n=39） and restrictive phenotype group （R-ES group, n=18）. MRI characteristics and outcomes of patients were compared between both groups. Results The incidence of atrial fibrillation and edema of lower extremity was significantly higher in R-ES than those in D-ES （72.22% [13/18]vs 30.77%;[12/39] 50.00%[9/18] vs 23.08%; both P〈0.05）. The left ventricular ejection function, left and right atrial anteroposterior diameter of D-ES group were significant smaller than those of R-ES group （all P〈0.05）, while the left ventricular （LV） short axis diameter, LV end diastolic/systolic volume and LV end diastolic/systolic volume index of D-ES were significantly greater than those of R-ES group （all P〈0.05）. Log-rank test found no significant difference between both groups in cardiovascular death/heart transplant events （χ^2=1.135, P=0.287）. Late gadolinium enhancement （LGE） volume fraction was significantly larger in D-ES （[36.1±14.8]%） than in R-ES （[21.0±9.0]%; P〈0.05）. There was a significant correlation between LGE volume fraction and cardiovascular death/heart transplant events （HR：1.054, P〈0.05）. Conclusion ES-HCM patients have expanded clinical expression and MRI characteristics, including dilated phenotype and restrictive phenotype. MRI has an important application value in the diagnosis and prognosis evaluation of ES-HCM.

关 键 词：心肌病 肥厚型 磁共振成像 

分 类 号：R542.2[医药卫生—心血管疾病] R445.2[医药卫生—内科学]