心脏MR评估肥厚型梗阻性心肌病经超声引导介入治疗后心肌结构与功能变化  

Evaluation of myocardial structure and function in patients with hypertrophic obstructive cardiomyopathy via cardiac MR after ultrasound-guided interventional therapy

作　　者：李爽昕 薛瑞佳 任子龙 何泽明 刘佳丽 郑敏文 LI Shuangxin;XUE Ruijia;REN Zilong;HE Zeming;LIU Jiali;ZHENG Minwen(Department of Radiology,Xijing Hospital,the Air Force Military Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学西京医院放射科,陕西西安710032

出　　处：《实用放射学杂志》2024年第2期213-216,221,共5页Journal of Practical Radiology

基　　金：国家重点研发计划项目(2022YFA1004204);国家自然科学基金青年科学基金项目(82202149)。

摘　　要：目的利用心脏磁共振(CMR)定量评估经超声引导下经皮心肌内室间隔射频消融术(PIMSRA)治疗后肥厚型梗阻性心肌病(HOCM)患者心脏结构和功能改变。方法回顾性分析行PIMSRA且术前及术后1年均行超声心动图及CMR检查的HOCM患者。运用Circle心血管成像后处理软件测量心肌的结构和功能参数,采用配对样本t检验和卡方检验对比术前及术后各参数的变化。结果与术前相比,术后1年患者的临床症状明显减轻,心功能显著改善。超声结果显示左室流出道压力阶差(LVOT-PG)显著降低,二尖瓣反流长度缩短(P<0.05)。CMR结果显示患者左心房收缩末期容积、左心房最小容积、三/四腔切面收缩末期左房横径、室间隔和左室游离壁的厚度均减少,左心室质量(LVM)显著降低,且差异均有统计学意义(P<0.001);左心房射血分数(LAEF)显著升高(P<0.05);乳头肌水平室间隔和左室游离壁的最大斜率和最大信号强度均升高(P<0.001),峰值时间显著降低(P<0.001)。结论PIMSRA治疗后HOCM患者左心房的收缩功能得到改善,左心室微循环灌注明显改善。Objective To evaluate the change of cardiac structure and function in patients with hypertrophic obstructive cardiomyopathy(HOCM)after ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)via cardiac magnetic resonance(CMR).Methods Patients with HOCM who underwent PIMSRA,echocardiography and CMR preoperative scanning and one year after surgery were analyzed retrospectively.Myocardial structural and functional parameters were measured by Circle cardiovascular imaging post-processing software.The changes of myocardial parameters before and after surgery were compared by using paired sample t-test and Chi-square test.Results Compared with the preoperative assessment,patients’clinical symptoms and the cardiac function were significantly improved one year after surgery.The left ventricular outflow tract pressure gradient(LVOT-PG)was significantly decreased and length of mitral regurgitation was shortened one year after surgery compared with before surgery via ultrasound(P<0.05).Compared with the preoperative assessment,CMR showed that patients with end-systolic volume of left atrium,minimum volume of left atrium,transverse diameter of left atrium,thickness of ventricular septum and free wall of left ventricular at end-systolic section were significantly reduced,and left ventricular mass(LVM)was significantly decreased one year after surgery,with statistical significance between before and after surgery(P<0.001).One year after surgery,the left atrium ejection fraction(LAEF)was significantly increased(P<0.05),the maximum slope and the maximum signal intensity of the ventricular septum and the left ventricular free wall of the papillary muscle were significantly increased(P<0.001),and the peak time was significantly decreased(P<0.001)compared with before surgery.Conclusion After PIMSRA treatment,the systolic function of left atrium in HOCM patients is improved,and the microcirculation perfusion of left ventricular is significantly improved.

关 键 词：肥厚型梗阻性心肌病 心脏磁共振 经皮心肌内室间隔射频消融术 

分 类 号：R542.2[医药卫生—心血管疾病] R445.2[医药卫生—内科学] R815[医药卫生—临床医学]