高血压性心脏病患者左室心肌纤维化与左房功能参数相关性的初步研究  

The relationship of left ventricular myocardial fibrosis and left atrial function parameters of patients with hypertensive heart disease

作　　者：夏睿 陶黎[1] 廖继春 张志伟[1] 杨海涛[1] 李咏梅[1] 吕发金[1] 郜发宝[2] XIA Rui;TAO Li;LIAO Jichun;ZHANG Zhiwei;YANG Haitao;LI Yongmei;LÜFajin;GAO Fabao(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Radiology,West China Hospital of Sichuan University,Chengdu 610044)

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016 [2]四川大学华西医院放射科,成都610044

出　　处：《磁共振成像》2022年第12期20-25,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:81601546)。

摘　　要：目的应用心脏磁共振(cardiac magnetic resonance,CMR)研究高血压性心脏病(hypertensive heart disease,HHD)患者左室心肌纤维化的特点及左房、左室心功能的变化,探讨分节段的心肌纤维化与左房、左室心功能参数的相关性。材料与方法回顾性分析2021年12月至2022年6月于重庆医科大学附属第一医院心内科诊断为HHD的患者病例16例(HHD组)与同时期健康对照者资料16例(对照组)。两组均扫描心脏电影序列测量左房射血分数(left atrial ejection fraction,LAEF)、左房舒张末期容积(left atrial end-diastolic volume,LAEDV)、左房收缩末期容积(left atrial end-systolic volume,LAESV)、左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左室收缩末期容积(left ventricular end-systolic volume,LVESV),分别在MR对比剂(钆喷酸葡胺)注射前及注射15 min后采集T1 mapping序列图像,采用CVI42后处理软件测量左室心肌细胞外容积(extracellular volume,ECV)并同时获得对比剂注射前的左室心肌T1值(pre-T1)。分心底、心肌中层、心尖三个层面和室间隔、心肌前壁、心肌侧壁和心肌下壁四个节段对ECV和pre-T1值和左房功能参数进行相关性分析。结果HHD组ECV、pre-T1高于对照组(t=2.363,P=0.030;t=2.100,P=0.014);LAEF、LVEF均低于对照组(t=-3.932,P<0.001;t=-4.251,P<0.001),LAEDV、LAESV、LVEDV、LVESV均高于对照组(t=2.732,P=0.010;t=4.223,P<0.001;t=2.898,P=0.010;t=3.208,P=0.006);HHD组心肌中层室间隔区域ECV、左室心底层面前壁、侧壁、心肌中层室间隔pre-T1值与LAEF存在线性相关(r=0.663,P=0.005;r=0.530,P=0.035;r=0.627,P=0.009;r=0.579,P=0.019)。结论HHD患者左心室出现弥漫性心肌纤维化,左房、左室心功能降低,其中左室部分节段与左房心功能参数之间存在一定的相关性,提示HHD患者左室心肌纤维化与左房心功能的恶化存在一定的因果关系,为左室心肌结构与Objective:To investigate the characteristics of left ventricular myocardial fibrosis and the changes of left atrial and ventricular cardiac function in patients with hypertensive heart disease(HHD)by cardiac magnetic resonance(CMR),and to analyze the correlation between segmental left ventricular fibrosis and left atrial and ventricular function parameters.Materials and Methods:Sixteen patients diagnosed with HHD cases(HHD group)in the Department of Cardiology of the First Affiliated Hospital of Chongqing Medical University from December 2021 to June 2022 and 16 data of healthy controls in the same period(control group)were retrospective analyzed.Left atrial ejection fraction(LAEF),left atrial end-diastolic volume(LAEDV),left atrial end-systolic volume(LAESV),left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),and left ventricular end-systolic volume(LVESV)were measured by cardiac cine sequences.T1 mapping sequence images were performed before and 15 min after the injection of Gd-DTPA.The commercial post-processing software was used to measure the left ventricular extracellular volume(ECV)and obtain the left ventricular myocardial T1 value(pre-T1)before contrast agent injection.The correlation between the values of ECV and pre-T1 and the functional parameters of the left atrium was analyzed in basal,midmyocardium and apex slices and ventricular septum,anterior myocardium,lateral myocardium and inferior myocardium segments.Results:ECV and pre-T1 of HHD group were higher than control group(t=2.363,P=0.030;t=2.100,P=0.014).LAEF and LVEF were lower than control group(t=-3.932,P<0.001;t=-4.251,P<0.001),LAEDV,LAESV,LVEDV and LVESV were higher than control group(t=2.732,P=0.010;t=4.223,P<0.001;t=2.898,P=0.010;t=3.208,P=0.006).There was a linear correlation between ECV of midmyocardial septum and LAEF in HHD group(r=0.663,P=0.005),and there was a linear correlation between pre-T1 of midmyocardial septum,basal anterior,basal lateral wall and LAEF(r=0.530,P=0.035;r=0.627,P=0.009;r=0.579,P=

关 键 词：高血压性心脏病 左心室 心肌纤维化 左心房 心功能参数 心脏磁共振 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.3[医药卫生—诊断学]