心脏磁共振对肥厚型心肌病左心房重构与继发性房颤的相关性研究  

The relationship between remodeling of left atrial and secondary atrial fibrillation in hypertrophic cardiomyopathy patients by cardiac magnetic resonance

作　　者：金凤强 王斌杰[1] 王长福[1,2] 李思雨 贺祥 靳海英[1] JIN Fengqiang;WANG Binjie;Wang Changfu;LI Siyu;HE Xiang;JIN Haiying(Department of Imaging Medicine,Huaihe Hospital of Henan University,Kaifeng 47500,CHN;Henan EngineeringResearch Center of Prostate Disease Prevention and Diagnosis,Kaifeng 47500,CHN)

机构地区：[1]河南大学淮河医院影像医学科,河南开封475000 [2]河南省前列腺疾病预防与诊断工程研究中心,河南开封475000

出　　处：《河南大学学报（医学版）》2022年第6期443-448,共6页Journal of Henan University:Medical Science

基　　金：河南省科技攻关计划(202102310087)。

摘　　要：目的:利用心脏磁共振(CMR)评价肥厚型心肌病(HCM)患者左心房(LA)结构与功能,探讨LA重构及功能受损与继发性房颤的相关性。方法:收录60例HCM患者,以58例CMR健康体检者为对照组。使用3.0T磁共振仪器扫描标准左心室的短轴、二腔心、四腔心等电影图像,分别测量LA相关参数:LA最大容积(即LA舒张末期容积,LAV-ED),LA收缩前容积(LAVpre-C),LA最小容积(LAV-ES),LA射血分数[EF,包括LA整体EF(LAEF-T)、LA被动EF(LAEF-P)、LA主动EF(LAEF-A)]。对LA各容积参数进行体表面积指数化,分析继发性房颤对HCM患者LA各参数的影响。利用ROC曲线分析LA参数对房颤的诊断效能,P<0.05认为有统计学差异。结果:HCM患者LAV-EDi、LAVpre-Ci、LAV-ESi较对照组明显增大[(61.33±18.33)mL/m^(2)vs.(37.98±10.86)mL/m^(2),(50.41±18.20)mL/m^(2)vs.(25.28±8.25)mL/m^(2),(37.12±19.61)mL/m^(2)vs.(15.84±5.99)mL/m^(2),P<0.05],LAEF-T、LAEF-P、LAEF-A较对照组明显减低[(41.93±17.39)%vs.(58.39±8.65)%,(18.91±8.60)%vs.(33.23±10.95)%,(28.81±18.22)%vs.(37.36±10.22)%,P<0.05]。合并房颤组的HCM患者LAV-ESi较非房颤组的明显增大[35.98(25.66,59.54)mL/m^(2)vs.(24.80±18.21)mL/m^(2),P<0.05],LAEF-T、LAEF-A明显减低[52.93%(41.72%,61.12%)vs.(52.73±17.10)%,20.62%(11.04%,36.18%)vs.(41.64±21.23)%,P<0.05]。LAV-ESi、LAEF-T、LAEF-A诊断房颤的ROC曲线下面积分别为0.75(95%CI=0.62~0.88,P<0.001)、0.81(95%CI=0.69~0.92,P<0.001)、0.85(95%CI=0.74~0.95,P<0.001)。结论:LA重构和功能受损程度可以用于预测继发性房颤的发生,CMR的LA研究具有较好的临床应用前景。Objective:To evaluate structure and function of left atrial(LA)in hypertrophic cardiomyopathy(HCM)patients by cardiac magnetic resonance(CMR),explore the relationship of the remodeling and dysfunction of LA and secondary atrial fibrillation.Methods:Sixty HCM patients and 58 normal controls were enrolled.All the study objects were performed at 3.0 T magnetic resonance scanner,including two-chamber,four-chamber,and LV short axis cine imaging.LA parameters:LA end-diastolic volume(LAV-ED),LA pre-atrial contraction volume(LAVpre-C),LA end-systolic volume(LAV-ES),LA ejection fraction(LAEF),consist of LA total EF(LAEF-T),LA passive EF(LAEF-P),LA active EF(LAEF-A)were measured.All data was indexed to body surface area.Analysis LA parameters influenced by atrial fibrillation.ROC curve analysis diagnostic value of LA parameters to atrial fibrillation.Results:In HCM patients,LAVmaxi、LAVpre-Ai、LAVmini was greater than controls[(61.33±18.33)mL/m^(2)vs.(37.98±10.86)mL/m^(2),(50.41±18.20)mL/m^(2)vs.(25.28±8.25)mL/m^(2),(37.12±19.61)mL/m^(2)vs.(15.84±5.99)mL/m^(2),P<0.05],LAEF-T、LAEF-P、LAEF-A was lower than controls[(41.93±17.39)%vs.(58.39±8.65)%,(18.91±8.60)%vs.(33.23±10.95)%,(28.81±18.22)%vs.(37.36±10.22)%,P<0.05].Patients with artial fibrillation showrd greater LAV-ESi[35.98(25.66,59.54)mL/m^(2)vs.(24.80±18.21)mL/m^(2),P<0.05],but lower LAEF-T、LAEF-A[52.93%(41.72%,61.12%)vs.(52.73±17.10)%,20.62%(11.04%,36.18%)vs.(41.64±21.23)%,P<0.05].ROC curve showed area under the curve is 0.75(95%CI=0.62~0.88,P=0.00),0.81(95%CI=0.69~0.92,P<0.001),0.85(95%CI=0.74~0.95,P<0.001)respectively of LAV-ESi,LAEF-T,LAEF-A to diagnose atrial fibrillation.Conclusion:Quantitatively evaluated LA structure and function in HCM patients showed the remodeling and dysfunction of LA was practicable to prognosis secondary atrial fibrillation.There is a good clinical application prospect of study in LA by CMR.

关 键 词：肥厚型心肌病 心脏磁共振 左心房 

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]