心脏磁共振评价心肌梗死后室壁瘤对左心室功能影响的研究  

Studying cardiac magnetic resonance imaging(CMR)to evaluate the effect of the ventricular aneurysm on the left ventricle function after myocardial infarction

作　　者：李巧玲[1] 魏子伦 李建辉 魏璇 梁静[3] 余鸿鸣[3] 牡丹[3] LI Qiaoling;WEI Zilun;LI Jianhui;WEI Xuan;LIANG Jing;YU Hongming;MU Dan(Department of Cardiovascular Medicine,Nanjing Drum Tower hospital,The Affiliated Hospitalof Nanjing University Medical School,Nanjing 210008,P.R.China;Gulou School of Clinical Medicine,The Affiliated Hospitalof Nanjing Medical University,Nanjing 210008,P.R.China;Department of Medical Imaging,Nanjing Drum Tower Hospital,The Affiliated Hospitalof Nanjing University Medical School,Nanjing 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院心血管内科,江苏南京210008 [2]南京医科大学鼓楼临床医学院,江苏南京210008 [3]南京大学医学院附属鼓楼医院影像科,江苏南京210008

出　　处：《医学影像学杂志》2020年第9期1592-1597,共6页Journal of Medical Imaging

基　　金：国家自然科学基金青年基金项目(编号:81900330,81601539);江苏省南京市医学科技发展基金项目(编号:QRX17057,QRX17113);江苏省博士后科研资助计划A类项目(编号:2019K060)。

摘　　要：目的探讨心脏磁共振(cardiac magnetic resonance,CMR)评价心肌梗死后室壁瘤对左心室功能的影响,并探究其对患者长期预后的指导作用。方法选取自2018年1月~2019年9月南京大学医学院附属鼓楼医院心肌梗死合并室壁瘤形成的行CMR的68例患者为观察对象,根据美国纽约心脏病学会分级(NYHA)将35例NYHAⅠ~Ⅱ级患者分为A组,33例NYHAⅢ~Ⅳ级患者为B组。对两组患者进行CMR检查,比较心功能参数及室壁瘤参数,分析室壁瘤对患者左心室心功能的影响。结果两组患者左心室收缩和舒张功能均不同程度减低,差异有统计学意义。CMR较心脏超声比较,敏感性和特异性更高,CMR较心脏彩超检测的左心室射血分数在两组间差异更加明显。在CMR检测数据中,与A组比较,B组患者的左心室舒张末容积、左心室收缩末容积、室壁瘤瘤体基底部横径、容积均显著升高,左心室射血分数、心输出量、峰值射血率均明显降低(P<0.05),室壁瘤瘤体高度有增高趋势,但差异无统计学意义。左心室射血分数与室壁瘤瘤体基底部横径及室壁瘤瘤体容积均呈负相关。左心室舒张末容积、左心室收缩末容积和室壁瘤容积呈正相关。结论心肌梗死室壁瘤形成后左心室收缩和舒张功能均与室壁瘤范围相关,CMR可精准测量心功能参数及室壁瘤范围,能准确评估心功能,对患者预后和临床治疗具有重要指导价值。Objective To evaluate the effect of ventricular aneurysm on left ventricular function after myocardial infarction by cardiac magnetic resonance(CMR),and to explore the guiding role of CMR on long-term prognosis of patients.Methods Fifty-eight cases are selected after CMR from myocardial infarction accompanied ventricular aneurysm at nanjing drum tower hospital,the affiliated hospital of nanjing university medical school,during the period of January,2018 to September,2019.They are divided into two groups according to NYHA:35 cases of NYHAⅠ~Ⅱas group A and 33 cases of NYHAⅢ~Ⅳas group B.CMR examinations are performed on these two groups,allowing the comparison of cardiac function and ventricular aneurysm parameters.The study on the effect of ventricular aneurysm on the patients’left ventricle cardiac function is further conducted.Results The two groups show different magnitude of decrease in the left ventricle systolic and diastolic function,the difference between them is of statistical significance.Compared to echocardiography,CMR exhibits higher sensitivity and specificity.On the other hand,left ventricular ejection fraction examined by CMR has a greater distinction between the two groups.In the CMR data,in contrast to group A,patients in group B demonstrate a remarkable increase in left ventricular end-diastolic volume,left ventricular end-systolic volume,ventricular aneurysm basilar transverse diameter and ventricular aneurysm volume.In group B,left ventricular ejec-tion fraction,cardiac output and peak ejection rate are significantly decreased(P<0.05).In addition,there is an upward tendency in the ventricular aneurysm height,which,however,shows no statistical difference.It can be noticed that a negative correlation exists between left ventricular ejection fraction and ventricular aneurysm basilar transverse diameter as well as ventricular aneurysm volume.On the contrary,there is a positive correlation between left ventricular end-diastolic volume or left ventricular end-systolic volume and ventricular

关 键 词：室壁瘤 心肌梗死 磁共振成像 

分 类 号：R732.1[医药卫生—肿瘤] R445.2[医药卫生—临床医学]