心脏磁共振技术在心肌肥厚性疾病中的诊断价值  

Diagnostic value of cardiac magnetic resonance in myocardial hypertrophy

作　　者：王玲玲[1] 姚秋英[2] 吴连明[2] 许建荣[2] 王姿[1] 姜萌[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心血管内科,上海200127 [2]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《上海医学》2017年第4期214-218,共5页Shanghai Medical Journal

基　　金：国家自然科学基金(81270206;81470391);上海交通大学医工交叉项目(YG2014MS49)资助

摘　　要：目的对可疑心肌肥厚的患者行心脏磁共振(CMR)检查,明确有无心肌肥厚、心肌肥厚的原因、评估心肌纤维化损伤的出现,并对CMR检查的安全性进行评估。方法收集2014年7月—2016年2月在上海交通大学医学院附属仁济医院就诊,心脏彩色多普勒超声(以下简称心脏超声)检查发现心肌任何部位舒张末厚度>11mm的可疑心肌肥厚的患者,行CMR检查明确有无心肌肥厚,心肌肥厚的原因,根据钆造影剂延迟强化阳性与否诊断患者是否存在心肌纤维化损伤,并对CMR检查的安全性进行评估。结果共收录216例可疑心肌肥厚患者。心脏超声检查与CMR检查对于心肌肥厚病因学诊断的符合率为82.4%(去除不明原因心肌肥厚患者)。心肌肥厚患者以高血压性心脏病和肥厚型心肌病(HCM)为主。CMR检查诊断为高血压性心脏病53例,HCM 117例,心肌淀粉样变3例,明确心肌肥厚病因的其他系统性疾病5例,不明原因心肌肥厚3例,明确诊断为其他疾病17例,明确无心肌肥厚18例。此外,CMR检查意外发现6例(2.8%)患者存在伴随病变。CMR检查确诊为心肌肥厚的患者中69.7%存在心肌纤维化,其中高血压性心脏病患者中38.9%存在心肌纤维化,显著低于HCM患者的82.1%(P<0.05)。除1例(0.5%)患者注射造影剂后即刻出现恶心、呕吐外,未见其他CMR检查相关不良反应。结论 CMR检查无创、安全,可为心肌肥厚的明确诊断提供更多的线索,并从病因学诊断更多的疾病,同时可加深对心肌肥厚的组织学损伤的认识。Objective To clarify the existence and etiology of myocardial hypertrophy and the presence of myocardial fibrosis in patients with echocardiographically suspected myocardial hypertrophy using cardiac magnetic resonance （CMR） examination, and to assess the safety of CMR examination. Methods Patients with echocardiographically suspected myocardial hypertrophy （defined as myocardial thickness at any segment 11 mm at the end of cardiac diastole） were recruited in our hospital between July 2014 and February 2016. CMR examination was performed in order to definitize the existence and the etiology of myocardial hypertrophy. The myocardial fibrosis was detected by the late gadolinium enhancement （LGE）. Moreover, CMR safety was assessed. Results Totally 216 patients were enrolled in this study. The agreement rate for etiologic diagnosis over myocardial hypertrophy was 82. 4% between CMR and echocardiography （patients with unexplained myocardial hypertrophy were excluded）. Hypertrophic cardiomyopathy and hypertensive heart disease were the main causes of hypertrophy. CMR examination found that 53 patients were confirmed as hypertensive heart disease, 117 patients with hypertrophic cardiomyopathy, 3 patients with myocardial amyloidosis, 5 patients with systemic diseases related myocardial hypertrophy, 3 patients with unexplained myocardial hypertrophy, 18 patients without hypertrophy, and 17 patients with a new diagnosis of other diseases. In addition, unexpected cardiac findings were detected by CMR in 6 patients （2.8 % ）. For the hyperenhancement, myocardial fibrosis wasfound in 69.7 % of the patients. The hyperenhancement rate was 38.9 % in the hypertensive heart disease group, which was significantly lower than that in the hypertrophic cardiomyopathy group （82. 1%, P〈0.05）. CMR- induced adverse reactions hardly appeared, except one patient （ 0.5% ） presented nausea and vomiting during contrast administration. Conclusion CMR is a noninvasive and safe strategy, which not only contributes more

关 键 词：心肌肥厚 心肌纤维化 肥厚型心肌病 高血压性心脏病 心脏磁共振 

分 类 号：R542.2[医药卫生—心血管疾病]