超声心动图联合心脏核磁共振成像在肥厚型心肌病不同亚型临床管理中的应用  

Echocardiography combined with cardiac magnetic resonance imaging in the clinical management of different subtypes of hypertrophic cardiomyopathy

作　　者：陈君美 艾慧俊[2] 戴丽雅 陈方红[2] CHEN Junmei;AI Huijun;DAI Liya;CHEN Fanghong(Zhejiang Chinese Medical University,Hangzhou 310053,China;不详)

机构地区：[1]浙江中医药大学,杭州310053 [2]丽水市中心医院超声医学科

出　　处：《心电与循环》2023年第1期61-65,共5页Journal of Electrocardiology and Circulation

摘　　要：目的 探讨超声心动图(UCG)联合心脏核磁共振成像(CMRI)在肥厚型心肌病(HCM)不同亚型临床管理中的应用。方法 选取2018年1月至2021年2月在丽水市中心医院确诊为HCM的78例患者为研究对象,根据CMRI检查结果及相关诊断标准分为心尖HCM(ApHCM)组21例,非对称性室壁HCM(ASHCM)组57例,比较两组患者CMRI及UCG参数。结果 两组患者钆延迟强化阳性率、左心室壁最厚处厚度、左心室射血分数(LVEF)等CMRI参数比较,差异均无统计学意义(均P>0.05)。ASHCM组患者左心房内径、室间隔舒张末期厚度、舒张末期二尖瓣血流A峰值(A)、左心室流出道或中腔梗阻发生率、室间隔舒张早期二尖瓣血流E峰值(E)/运动峰值(e’)、侧壁E/e’、平均E/e’均明显高于ApHCM组,而室间隔e’、侧壁e’均明显低于ApHCM组,差异均有统计学意义(均P<0.05);两组患者左心室后壁舒张末期厚度、左心室舒张末期内径、左心室舒张末期容积、LVEF、E、E/A比较,差异均无统计学意义(均P>0.05)。结论 ASHCM患者的左心室流出道或中腔梗阻发生率明显高于ApHCM患者,且左心室舒张功能较ApHCM患者差,但心肌纤维化差异不明显。Objective To investigate the use of echocardiography(UCG) combined with cardiac magnetic resonance imaging( CMRI) in the clinical management of different subtypes of hypertrophic cardiomyopathy(HCM), providing imaging basis for clinically stratified management. Methods Seventy-eight patients diagnosed with HCM in Lishui Central Hospital from January 2018 to February 2021 were selected, and were classified into 21 cases of apical HCM(ApHCM) and 57 cases of asymmetric ventricular HCM(AsHCM) according to CMR findings. And CMR and UCG parameters were compared between the two groups, including general clinical data, left ventricular outflow tract or middle lumen obstruction, 2D-UCG parameters, blood flow spectrum and tissue Doppler parameters. Results There were no statistically significant differences in gender, age, heart rate and blood pressure between ApHCM and AsHCM groups(P >0.05). There were no significant differences in positive rate of late gadolinium enhancement(LGE) and CMR ejection fraction(EF) between ApHCM and AsHCM groups(all P >0.05). In UCG parameters between ApHCM and AsHCM groups, there were statistically significant differences in the incidence of left ventricular outflow tract or mid-chamber obstruction, left atrial anteroposterior diameter, interventricular end-diastolic thickness, A peak, interventricular septum E lateral wall E, interventricular septum E/e’, lateral wall E/e’ and average E/e’ values(all P<0.05). There was no statistical significance in the remaining parameters(all P >0.05). Conclusion After excluding the influence of left ventricular wall thickness by matching method, the left ventricular outflow tract or mid-chamber obstruction in AsHCM patients was significantly higher than that in ApHCM patients, and left ventricular diastolic function was worse than that in ApHCM patients. But there was no significant difference in the incidence of myocardial fibrosis between the two groups.

关 键 词：心尖肥厚型心肌病 非对称性室间隔肥厚型心肌病 钆延迟强化 左心室流出道或中腔梗阻 左心室舒张功能 

分 类 号：R542.2[医药卫生—心血管疾病]