心脏磁共振测量心外膜下脂肪组织厚度在高血压合并心律失常中的应用  

Application of cardiac magnetic resonance derived epicardial adipose tissue thickness in hypertension comorbid with arrhythmias

作　　者：潘子怡 杨朝霞 唐大中 黄璐[1] 夏黎明[1] PAN Zi-yi;YANG Zhao-xia;TANG Da-zhong(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《放射学实践》2024年第11期1481-1487,共7页Radiologic Practice

基　　金：国家自然科学基金项目(81873889)。

摘　　要：目的:探讨心脏磁共振(CMR)技术定量分析心外膜下脂肪组织(EAT)厚度在高血压合并心律失常中的应用价值。方法:回顾性分析2020年1月-2020年11月于本院诊治的高血压不伴心律失常(HTN-NA)患者、高血压伴房性心律失常(HTN-AA)患者及高血压伴室性心律失常(HTN-VA)患者各24例,以及年龄与性别相匹配的健康志愿者24例。所有研究对象进行3.0T CMR检查,EAT厚度在心脏电影图像上进行测量。采用CVI42商业后处理软件测量左心房及左心室的功能及心肌应变参数。以单因素方差分析或Kruskal-Wallis检验(均由Bonferroni校正)比较四组组间基线资料中连续性变量的差异,以协方差分析比较四组组间CMR参数的差异。采用受试者操作特征(ROC)曲线下面积(AUC)分析EAT厚度鉴别HTN-AA与HTN-NA、HTN-VA与HTN-NA的诊断效能。结果:与对照组比较,高血压患者的左心室质量指数(LVMi)增高,整体长轴应变(GLS)减低(P<0.05);与HTN-NA组及对照组比较,HTN-AA组的左心房最大、最小及收缩前容积指数(LAVi_(max)、LAVi_(min)、LAVi_(bac))增高,总应变及主动应变(εs和εa)减低,差异具有统计学意义(P<0.05)。高血压合并心律失常患者的右房室间沟(RAVG)、前室间沟(AIVG)、下室间沟(IIVG)、上室间沟(SIVG)和右心室游离壁(RVFW)的EAT厚度均高于HTN-NA组及对照组(P<0.05)。ROC曲线结果显示,在鉴别高血压合并心律失常患者与高血压不合并心律失常患者时,IIVG和RVFW的诊断效能较高(AUC:0.831~0.899)。结论:CMR成像测量的EAT厚度参数在鉴别高血压合并心律失常与不合并心律失常中具有较高的诊断效能,这可能为进一步研究EAT厚度在高血压及心律失常治疗干预方面提供了新的方向。Objective:To evaluate the value of cardiac magnetic resonance(CMR)derived epicardial adipose tissue(EAT)thickness in hypertension comorbid with arrhythmias.Methods:From January 2020 to November 2020,24 hypertension with no arrhythmias(HTN-NA),24 hypertension with atrial arrhythmias(HTN-AA),24 hypertension with ventricular arrhythmias(HTN-VA),and 24 age-and gender-matched normotensive controls who underwent 3.0T CMR examination were retrospectively enrolled.EAT thickness was measured on cine images.CMR conventional parameters were analyzed using commercial software CVI42.One-way analysis of variance or Kruskal-Wallis test both with Bonferroni correction was performed to compare the differences in continuous variables of baseline data among the four groups,and analysis of covariance was used to compare the differences in CMR-derived parameters among the four groups.Receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic performance of EAT thickness metrics for differentiating the HTN-AA group or HTN-VA group from the HTN-NA group.Results:Patients with hypertension had higher left ventricular mass index(LVMi),and impaired global longitudinal strain(GLS)than controls(all P<0.05).Compared with the HTN-NA group and controls group,left atrial maximum,minimum,and before atrial contraction volume index(LAVi _(max),LAVi _(min),LAVi _(bac))statistically increased,as well as reservoir and booster pump strain(εs,εa)were statistically impaired in HTN-AA group(all P<0.05).Additionally,hypertensive patients with arrhythmias had higher EAT thickness in the right atrioventricular groove(RAVG),anterior interventricular groove(AIVG),inferior interventricular groove(IIVG),superior interventricular groove(SIVG),and right ventricular free wall(RVFW)than HTN-NA patients and controls(all P<0.05).ROC analysis showed that IIVG and RVFW had higher diagnostic value for differentiation of hypertensive patients with arrhythmias from· hypertensive patients without arrhythmias(AUC:0.831~0.899).Conclusion:CM

关 键 词：高血压 心律失常 心脏磁共振成像 心外膜下脂肪 

分 类 号：R445.2[医药卫生—影像医学与核医学] R544.1[医药卫生—诊断学] R541.7[医药卫生—临床医学]