心脏磁共振延迟钆增强预测置入型心律转复除颤器置入后室性心律失常的价值  

Value of late gadolinium enhancement cardiac MRI in predicting ventricular arrhythmia in patients with ICD

作　　者：宋玲毓 李健[2] 张闯[2] 杨漫漫 张国星 苏小雅 时向民 Song Lingyu;Li Jian;Zhang Chuang;Yang Manman;Zhang Guoxing;Su Xiaoya;Shi Xiangmin(Navy College of Clinical Medicine/the Fifth School of Clinical Medicine,Anhui Medical University,Hefei 230032,Anhui Province,China)

机构地区：[1]安徽医科大学第五临床学院海军临床学院,合肥230032 [2]解放军总医院第六医学中心心血管内科

出　　处：《中华老年心脑血管病杂志》2025年第2期132-135,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国防科技创新课题(20-163-02-ZT-008-007-01)。

摘　　要：目的探讨心脏磁共振延迟钆增强(late gadolinium enhancement,LEG)在预测置入型心律转复除颤器(implantable cardioverter defibrillator,ICD)置入后发生室性心律失常(ventricular arrhythmia,VA)事件中的应用价值。方法回顾性分析2020年6月至2024年3月解放军总医院第一医学中心和第六医学中心ICD置入并行LEG检查的心源性猝死高危患者16例,根据随访期间是否发生ICD恰当治疗的VA事件分为VA组7例和无VA组9例。比较2组临床基线特征、LEG特点与发生VA事件的相关性。结果VA组术后透壁性强化、心肌中层强化比例明显高于无VA组(71.4%vs 11.1%,P=0.035;85.7%vs 22.2%,P=0.041)。多因素logistic回归分析显示,透壁性强化(OR=5.000,95%CI:0.150~166.589,P=0.368)和心肌中层强化(OR=7.000,95%CI:0.217~226.005,P=0.272)不是VA的独立影响因素。ROC曲线分析显示,透壁性强化和心肌中层强化联合预测及单独透壁性强化的诊断效能较好(P<0.05)。结论LEG对预测患者置入ICD后发生VA事件具有临床价值。Objective To investigate the application value of late gadolinium enhancement(LEG)at cardiac MRI in predicting ventricular arrhythmia(VA)events in patients after implantation of ICD.Methods A retrospective analysis was performed on 16patients at high risk of sudden cardiac death after ICD implantation and LEG examination in the First and the Sixth Medical Centers of Chinese PLA General Hospital from June 2020to March 2024.According the occurrence of VA events receiving appropriate ICD therapy during the follow-up period,they were divided into postoperative VA group(7cases)and non-VA group(9cases).The correlation of clinical baseline features and LEG features with VA events was analyzed.Results The ratios of transmural enhancement and myocardial medium enhancement were obviously higher in the VA group than the non-VA group(71.4%vs 11.1%,P=0.035;85.7%vs 22.2%,P=0.041).Multivariate logistic regression analysis showed that transmural enhancement(OR=5.000,95%CI:0.150-166.589,P=0.368)and myocardial medium enhancement(OR=7.000,95%CI:0.217-226.005,P=0.272)were not independent factors influencing VA occurrence.ROC curve analysis indicated that the combined prediction of transmural enhancement and myocardial media enhancement and the prediction of transmural enhancement alone had better diagnostic efficacy(P<0.05).Conclusion LEG has clinical value in predicting postoperative VA events in patients after ICD implantation.

关 键 词：心律失常 心性 除颤器 植入型 磁共振成像 预测 

分 类 号：R541.7[医药卫生—心血管疾病]