左心室流出道相关解剖学参数对肥厚性心肌病血流动力学的影响  

Influence of Anatomic Parameters of Left Ventricular Outflow Tract on Hemodynamics in Hypertrophic Cardiomyopathy

作　　者：徐盼盼 朱晓梅[1] 陈杨 徐怡[1] 祝因苏[1] XU Panpan;ZHU Xiaomei;CHEN Yang;XU Yi;ZHU Yinsu(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《中国医学影像学杂志》2021年第9期866-871,共6页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(81701651)。

摘　　要：目的探讨心脏MR左心室流出道(LVOT)收缩末期(ES)解剖学参数对肥厚性心肌病(HCM)血流动力学的影响。资料与方法回顾性收集81例HCM(梗阻型30例,非梗阻型51例)和40例正常对照组。MR电影三腔心测量二尖瓣前叶长度(AML),包括部分AML(PAML)和总AML(TAML),LVOT的ES及舒张末期(ED)直径(LVOT_(ES)、LVOT_(ED));并计算相关比值。短轴位测量ES和ED基底部前室间隔(BAIS)厚度(BAIS_(ES)、BAIS_(ED))。比较3组上述参数的差异,用多因素二元Logistic回归分析ES参数、ED参数、两期联合参数对LVOT是否梗阻的影响,并获得预测模型。采用多因素步进法线性回归分析LVOT压力阶差的独立预测因子。结果3组LVOT解剖学参数PAML、TAML、LVOT_(ES)、LVOT_(ED)差异均有统计学意义(F=5.2、11.6、29.1、44.7,P均<0.01)。梗阻型HCM的BAIS_(ED)均>15 mm。ES解剖学参数的预测模型(BAIS_(ES)+LVOT_(ES))对LVOT梗阻的预测准确率(82.7%)不低于ED参数(80.2%)及两期联合参数(82.7%)。PAML/LVOT_(ES)是LVOT压力阶差的独立预测因子(R=0.507,P=0.005)。结论LVOT的ES解剖学参数可以预测LVOT是否梗阻,而LVOT压力阶差仅与ES参数相关,与ED参数无关。Purpose To investigate the influence of end-systole(ES)anatomic parameters of left ventricular outflow tract(LVOT)by cardiac magnetic resonance on hemodynamics in hypertrophic cardiomyopathy(HCM).Materials and Methods Eighty-one patients with HCM(30 patients with obstruction and 51 patients with non-obstruction)and forty controls were retrospectively included.Anterior mitral valve length(AML)including partial AML(PAML)and total AML(TAML),as well as the diameters of LVOT during ES(LVOT_(ES))and end-diastole(LVOT_(ED))were measured in 3-chamber views,respectively.The ratio of AML and LVOT were further calculated.The short axis views were used to measure the thickness of basal anterior interventricular septum(BAIS)including BAISES and BAISED.The differences of the parameters mentioned above among the three groups were compared.The obstructive status and the anatomic parameters on the LVOT gradient were analyzed via binary Logistic regression and linear regression,respectively.Results BAISED of obstructive HCM was thicker than 15 mm.The accuracy of prediction model of ES anatomic parameters(82.7%by BAISES+LVOT_(ES))was not lower than that of ED parameters(80.2%)and the combined parameters(82.7%).Additionally,PAML/LVOT_(ES) was the independent predictor of LVOT gradient(R=0.507,P=0.005).Conclusion ES anatomic parameters of LVOT can predict obstruction status,and LVOT gradient is exclusively associated with ES parameters,but not ED parameters.

关 键 词：心肌病 肥厚性 心室流出道梗阻 磁共振成像 二尖瓣 血流动力学 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]