应用心脏核磁共振成像评价高血压相关收缩性心力衰竭患者左心室形态改变  

Clinical value of cardiac magnetic resonance in patients with hypertension complicated with systolic heart failure

作　　者：于海奕[1] 莫小丽 王新宇[1] 王莹[3] 王晓华[3] 张幼怡[1] 高炜[1] YU Hai-yi;MO Xiao-li;WANG Xin-yu;WANG Ying;WANG Xiao-hua;ZHANG Youyi;GAO Wei(Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research,100191 Beijing,China)

机构地区：[1]北京大学第三医院心内科血管医学研究所国家卫生健康委心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室心血管受体研究北京市重点实验室,北京100191 [2]清华大学医院内科 [3]北京大学第三医院放射科

出　　处：《中国介入心脏病学杂志》2019年第2期64-69,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81871850);北京大学第三医院优秀留学回国人员科研启动基金;北京大学第三医院临床重点项目(BYSY2016015)

摘　　要：目的应用心脏核磁共振成像比较非缺血性心脏病心力衰竭患者中,合并高血压与未合并高血压患者的左心室形态改变。方法连续入选合并高血压且临床诊断考虑高血压为主要心力衰竭病因的患者20例作为心力衰竭合并高血压组;以同时期性别及左心室射血分数匹配的不伴有高血压的心力衰竭患者21例作为心力衰竭未合并高血压组。两组均行增强心脏核磁共振成像检查,比较其左心室舒张末期内径(LVDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)及各室壁厚度的差异。结果心力衰竭合并高血压组与心力衰竭未合并高血压组患者LVEDV、LVEDVI、LVESV、LVESVI、LVDD等反映左心室扩张的指标比较,差异均无统计学意义(均P>0.05);左心房和右心房面积、左心室质量指数、纤维化发生率比较,差异均无统计学意义(均P>0.05)。心力衰竭合并高血压组患者平均最大室壁厚度较心力衰竭未合并高血压组更厚[(10.1±1.4)mm比(7.1±1.2)mm,P=0.001],各个室壁厚度均显著大于后者,其中前间隔和后间隔最大室壁厚度差异尤为显著。心力衰竭合并高血压组患者左心室质量[(182.1±56.0)g比(122.7±38.9)g,P<0.001]显著高于心力衰竭未合并高血压组,但右心室运动异常[20.0%比71.4%,P=0.001]显著低于心力衰竭未合并高血压组,差异均有统计学意义。结论高血压相关的收缩性心力衰竭患者,左心室扩张程度与不伴有高血压的非缺血性心力衰竭患者相似,但其左心室壁厚度显著增高。给予心力衰竭合并高血压患者早期诊断及积极治疗,其心功能有可能改善。Objective To investigate whether hypertension is related to the left ventricular morphology and function in non-ischemic heart disease patients with systolic heart failure by cardiac magnetic resonance image (CMRI). Methods Twenty consecutive patients with systolic heart failure were included as the study group. The eading cause of heart failure was determined by the clinician as hypertension, and all the patients were admitted for the first time for heart failure. Another 21 patients with heart failure admitted during the same period but without hypertension, were matched in age, sex and LVEF and selected as the control group. Results Left ventricular end-diastolic volume (LVEDV) in patients with hypertension was (274.8±79.2) ml, and left ventricular end-systolic volume (LVESV) was (202.7±78.0) ml. While, LVEDV in the control group was (247.0±64.0) ml and LVESV was (148.2±42.5) ml. There was no difference in LV dilation between the study group and the control group(all P >0.05). The maximal wall thickness in the patients with hypertension (10.1±1.4) mm was thicker than that in the control group (7.1±1.2) mm(P=0.001). Patients in the study group had higher LV mass than patients in the control group[(182.1±56.0)g比(122.7±38.9)g,P<0.001].One year follow-up showed that 80% of patients in the study group had improvement in heart function. Conclusions In patients with hypertension-related systolic heart failure, left ventricular dilatation is similar to nonhypertension systolic heart failure, but left ventricular wall thickness is significantly increased. Early diagnosis and active treatment of patients with hypertension-related systolic heart failure,can enhance clinical outcome and improve in heart function.

关 键 词：高血压 心脏核磁共振成像 心力衰竭 左心室形态 

分 类 号：R541.3[医药卫生—心血管疾病]