扩张型心肌病左心室游离壁心肌钆延迟强化类型初探  

Late gadolinium enhancement distribution pattern of left ventricular wall in patients with dilated cardiomyopathy:a preliminary study

作　　者：李睿[1,2,3] 崔辰[1] 兰天 陈秀玉[1] 尹刚[1] 陆敏杰[1] 赵世华[1] Li Rui;Cui Chen;Lan Tian;Chen Xiuyu;Yin Gang;Lu Minjie;Zhao Shihua(Department of Magnetic Resonance Imaging,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union,Beijing 100037,China;Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Sichuan Key Laboratory of Medical Imaging,Nanchong 637007,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院磁共振影像科,100037 [2]川北医学院附属医院放射科,医学影像四川省重点实验室,南充637007 [3]中国医学科学院阜外医院博士后流动工作站

出　　处：《中华心血管病杂志》2020年第11期922-929,共8页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81620108015,81801674)。

摘　　要：目的探讨扩张型心肌病(DCM)患者左心室游离壁钆延迟强化(LGE)的类型。方法回顾性分析中国医学科学院阜外医院2018年1月1日至12月31日临床诊断为DCM并且接受了心脏磁共振和CT血管造影(CTA)检查患者的临床资料。通过电子病历系统收集入选患者的基线临床资料。分析入选患者左心室游离壁LGE的类型、累及范围及其分布特征。结果研究共入选患者130例,其中56例(43.1%)存在左心室游离壁LGE,室间隔和左心室游离壁联合LGE者占94.6%(53/56)。与LGE阴性的患者比较,左心室游离壁LGE的患者纽约心脏协会心功能Ⅲ/Ⅳ级者的比例较高,左心室射血分数较低,室内传导阻滞、短阵室性心动过速和继发二尖瓣关闭不全的比例较高,左心室舒张/收缩末期容积、左心室舒张/收缩末期容积指数、左心室舒张末期横径均较大(P均<0.05)。56例患者中存在心外膜下LGE者19例,累及心肌节段[60.8%(127/209)]明显大于肌壁间LGE[30例,32.4%(107/330)]、透壁LGE[21例,32.5%(75/231)]及心内膜下LGE[9例,26.3%(26/99)](P均<0.01)。在累及区域方面,21例透壁LGE患者累及区域依次为左心室下侧壁的心基底部(18/21)和中部(13/21)、前侧壁的心基底部(15/21)和中部(11/21)以及下壁的心中部(9/21);19例心外膜下LGE患者的累及区域依次为左心室下侧壁的心基底部(13/19)和中部(16/19)、前侧壁的心基底部(13/19)和中部(15/19)、侧壁心尖部(13/19)、前壁和下壁的中部(12/19、10/19)和心尖部(15/19、10/19);30例肌壁间LGE患者的累及区域依次为左心室前壁及下壁的心基底部(19/30、16/30)和中部(18/30、14/30)。56例存在左心室游离壁LGE的患者中单一及混合LGE模式的患者分别有23及33例。与单一型LGE模式的患者比较,混合型LGE模式的患者累及心肌范围更广[60.9%(154/253)比49.9%(181/363),P=0.007]。入选的130例DCM患者中23例进行了心脏移植。单独室间隔和室间隔与左心室游离壁Objective To investigate the distribution pattern of late gadolinium enhancement(LGE)in left ventricular free wall of patients with dilated cardiomyopathy(DCM).Methods A total of 130 consecutive DCM patients who were hospitalized in our hospital,underwent both CMR and CTA examinations and met the inclusion and exclusion criteria including negative results of coronary angiography or coronary CTA,were retrospective included in this study.The LGE pattern,extent and distribution in left ventricular free wall were analyzed.Results Left ventricular free wall LGE was detected in 56 out of 130 DCM patients.LGE was observed in both septal and free wall in 53 out of 56 patients with LGE(94.6%).Prevalence of NYHA classificationⅢ/Ⅳ,intraventricular block,paroxysmal ventricular tachycardia,and secondary mitral insufficiency was significantly higher,while left ventricular ejection fraction was significantly lower,left ventricular end-diastolic/systolic volume,left ventricular end-diastolic/systolic volume index and left ventricular end-diastolic diameters values were larger in patients with LGE than without LGE(all P<0.05).In terms LGE pattern among these 56 patients,percent of involved myocardial segments in patients with subepicardial LGE(n=19)was significantly higher than patients with intermural LGE(n=30),patients with transmural LGE(n=21),and patients with subendocardial LGE(n=9)(60.8%(127/209)vs.32.4%(107/330),32.5%(75/231),26.3%(26/99),respectively,all P<0.01).Transmural LGE was most likely to involve the left ventricular inferior lateral basal(18/21)and mid(13/21)segment,followed by anterior lateral basal(15/21)and mid(11/21)segments and inferior mid segment(9/21).Subepicardial LGE was more likely to occur in the inferior lateral basal(13/19)and mid(16/19)segment,anterior lateral basal(13/19)and mid(15/19)segment,anterior lateral basal(13/19)and mid(15/19)segment,lateral apical(13/19),anterior and inferior mid segment(12/19 and 10/19),and apical segment(15/19 and 10/19).Intermural LGE mostly involved the anterior a

关 键 词：心肌病 扩张型 磁共振成像 钆延迟强化 

分 类 号：R542.2[医药卫生—心血管疾病]