心脏磁共振成像在评价三尖瓣下移畸形临床严重程度中的价值  

Value of cardiac magnetic resonance imaging in evaluating the clinical severity of Ebstein anomaly

作　　者：李嘉华 程维琴 黄美萍 庄建[4,5,7] 钟小梅 贾乾君[2] 刘辉[2] 梁长虹[2] LI Jia-hua;CHENG Wei-qin;HUANG Mei-ping;ZHUANG Jian;ZHONG Xiao-mei;JIA Qianjun;LIU Hui;LIANG Chang-hong(Shantou University Medical College,Shantou,Guangdong 515041,China;Department of Radiology,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Southern Medical University,Guangzhou 510515,China;Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Guangdong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Catheterization Lab,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Cardiac Surgery,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]广东省人民医院(广东省医学科学院)放射科,广州510080 [3]南方医科大学,广州510515 [4]广东省华南结构性心脏病重点实验室广东省人民医院(广东省医学科学院),广州510080 [5]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510080 [6]广东省人民医院(广东省医学科学院)介入导管室,广州510080 [7]广东省人民医院(广东省医学科学院)心外科,广州510080

出　　处：《岭南心血管病杂志》2017年第6期726-730,758,共6页South China Journal of Cardiovascular Diseases

基　　金：国家自然-广东联合基金重点支持项目:基于多模态影像融合与可视化的复杂先心病手术辅助关键技术研究(项目编号:U1401255);"十一五"国家科技支撑计划项目:提高新生儿及小婴儿复杂先心病外科疗效的临床研究(项目编号:2006BAI01A08);"十二五"国家科技支撑计划项目:复杂先心病防治网络建设和优化治疗策略研究(项目编号:2011BAI11B22);广东省科技计划项目:小儿复杂先心病MRI检查技术及诊断优化研究(项目编号:2013B031800006);广州市科技计划项目:小儿复杂先心病MRI检查技术及诊断优化研究(项目编号:201510010255)

摘　　要：目的寻找能比较准确评价三尖瓣下移畸形(Ebstein anomaly,EA)患者临床严重程度的心脏磁共振(cardiac magnetic resonance,CMR)成像指标。方法回顾性分析20例经手术证实的EA患者的CMR资料,分别测量右心房(right atrial,RA)、左心房(left atrial,LA)、房化右心室(atrialized right ventricular,aRV)、功能右心室(functional right ventricular,fRV)、左心室(left ventricular,LV)舒张末期容积(end diastolic volume,EDV)、面积和直径(end diastolic diameter,EDD),计算容积指标:fRVEDV/LVEDV、(RA+aRV)/(fRV+LA+LV)及(RA+aRV+fRV)/(LA+LV);面积指标:(RA+aRV)/(fRV+LA+LV)及内径指标:fRVEDD/LVEDD,并分别与已被确认的评价EA临床严重程度的指标:脑钠肽(brain natriuretic peptide,BNP)、纽约心脏协会(New York Heart Associa-tion,NYHA)心功能分级、胸片中的心胸比(cardio-thoracic ratio,CTR)及超声心动图中的左心室射血分数(leftventricular ejection fraction,LVEF)和三尖瓣反流程度(tricuspid regurgitation,TR)行相关性分析。结果 (RA+aRV+fRV)/(LA+LV)容积比与BNP(r=0.599,P=0.011),NYHA心功能分级(r=-0.370,P=0.108)及TR(r=0.534,P=0.015)有相关性。其余4个CMR指标只与较少的临床上反映严重程度的指标具有相关性。结论 (RA+aRV+fRV)/(LA+LV)容积比在EA患者中与最多的临床上反映严重程度的指标具有相关性,能较其他指数更好地评估EA患者的临床严重程度。Objectives To find out the indices from cardiac magnetic resonance(CMR)imaging which can relativelyand accurately evaluate clinical severity of patients with Ebstein anomaly(EA).Methods Totally20patients′CMRdata were analyzed.Left and right atrial and ventricular functions were measured on images of cine series,includingright atrial(RA),left atrial(LA),atrialized right ventricular(aRV),functional right ventricular(fRV)and left ven?tricular(LV)end diastolic volume(EDV),area and end diastolic diameter(EDD),to calculate volume index:fRVEDV/LVEDV,(RA+aRV)/(fRV+LA+LV)and(RA+aRV+fRV)/(LA+LV);area index:(RA+aRV)/(fRV+LA+LV)and diameter index:fRVEDD/LVEDD.Correlation analysis was done between functional indices and severity indi?ces which were confiremed to be indices for clinical severity.The later one included brain natriuretic peptide(BNP),New York Heart Association(NYHA)classification,cardio-thoracic ratio(CTR)of chest X ray,left ventricularejection fraction(LVEF)and tricuspid regurgitation(TR)of echocardiography.Results(RA+aRV+fRV)/(LA+LV)correlated well with NYHA classification(r=-0.370,P=0.108),BNP(r=0.599,P=0.011)and TR(r=0.534,P=0.015).The remaining4indices corresponded less with clinical parameters.Conclusions(RA+aRV+fRV)/(LA+LV)associated with most clinical severity indices in patients with EA,allowing more accurate assessment of disease se?verity than other indices.

关 键 词：心脏缺损 先天性 三尖瓣下移畸形 心脏磁共振成像 

分 类 号：R541.1[医药卫生—心血管疾病]