DE-CMR在主动脉关闭不全患者手术预后评估中的应用分析  

The Application of DE-CMR in Evaluation of the Prognosis of Patients with Aortic Insufficiency after Surgery

作　　者：孟庆江[1] 张双林[1] 郑先杰[1] 张国愉 董彦军[1] 孙明飞[1] 

机构地区：[1]河南大学第一附属医院胸心血管外科,河南开封475000

出　　处：《中国CT和MRI杂志》2017年第8期146-148,152,共4页Chinese Journal of CT and MRI

基　　金：河南省科技厅基金项目(编号152300410193)

摘　　要：目的探讨造影剂延迟增强心脏磁共振成像(DE-CMR)在主动脉关闭不全(AI)患者手术预后评估中的应用价值。方法回顾性分析行手术治疗的AI患者48例病例资料,根据术前DE-CMR检查是否出现钆对比延迟增强分为增强组和非增强组,比较两组患者的资料特征,随访至2017年3月记录不良预后发生情况,并分析不良预后的预测因子。结果 48例患者中,钆剂延迟增强患者17例(35.42%),非钆剂延迟增强患者31例(64.48%);两组患者性别、年龄、高血压、糖尿病、术前心功能分级比较,差异无统计学意义(P>0.05),增强组术前LVESD、LVEDD、左心房前后径、左心室最大横径均大于非增强组,(P<0.05),随访期间室性心律失常、心功能进展为Ⅲ-Ⅳ级、死亡的几率分别为23.52%、35.29%、29.41%高于非增强组的3.23%、9.68%、6.45%(P<0.05);Cox比例风险模型分析显示LVEDD、LVESD、左心房前后径是AI术后不良预后的独立预测因子。结论 DE-CMR诊断AI可提供更加全面的影像学资料,其中钆对比剂延迟增强识别的心肌纤维化可预测不良预后。Objective To investigate the application value of contrast delayed enhanced cardiac magnetic resonance imaging （DE-CMR） in evaluation of the prognosis of patients with aortic insufficiency （AI） after surgery.Methods The medical records of 48 patients with AI treated by surgery were retrospectively analyzed. According to the occurrence of gadolinium contrast delayed enhancement of DE-CMR before surgery, the patients were divided into the enhancement group and the non-enhancement group, and the data of the two groups were compared. All patients were followed up to March 2017, and the incidence of adverse prognosis was recorded and the predictors of adverse prognosis were analyzed.Results Of the 48 patients, 17 patients had delayed gadolinium enhancement （35.42%） and 31 patients did not have （64.48%）. There were no significant differences between the two groups in gender, age, hypertension, diabetes and grade of cardiac function before surgery （P〉0.05）. Before surgery, the LVESD, LVEDD, left atrial anteroposterior dialneter and the maximum left ventricular diameter of the enhancement group were greater than those of the non-enhancement group （P〈0.05）. During the follow-up, the probabilities of ventricular arrhythmia, heart function, cardiac ftlnction progressing to grade III-IV and death rates in the enhancement group （23.52%, 35.29%, 29.41%） were higher than those in the non-enhancement group （3.23%, 9.68%, 6.45%） （P〈0.05）. Cox proportional hazards lnodel analysis showed that LVEDD, LVESS, left atrial anteroposterior diameter were independent predictors ot adverse prognosis after AI surgery.Conclusion DE-CMR can provide more comprehensive imaging data for diagnosis of Al, and myocardial fibrosis identified by gadolinium delayed enhancement can predict the adverse prognosis.

关 键 词：心脏磁共振成像 钆喷酸葡胺 对比剂 延迟增强 预后 

分 类 号：R543.1[医药卫生—心血管疾病]