心房颤动射频消融术后心肌瘢痕的心脏磁共振研究  

LGE-CMR Study of Myocardial Scar After Radiofrequency Ablation for Atrial Fibrillation

作　　者：李雪莲 徐茂森 王志华 李承宗 陈文苏 韩曙光 张卓琦 张晓艳 LI Xuelian;XU Maosen;WANG Zhihua(Department of Cardiology,Yancheng First People's Hospital,Yancheng,Jiangsu Province 224002,P.R.China)

机构地区：[1]盐城市第一人民医院心内科,240002 [2]徐州医科大学附属医院心内科,221000 [3]徐州医科大学附属医院医学影像中心,221000 [4]徐州市中医院放射科,221000

出　　处：《临床放射学杂志》2025年第3期444-449,共6页Journal of Clinical Radiology

基　　金：盐城市医学科技项目(编号:YK2018002)。

摘　　要：目的探究与分析心脏增强磁共振(LGE-CMR)定量评估心房颤动射频消融术(CPVA)后左心房心肌瘢痕程度的应用价值。方法回顾性分析徐州医科大学附属医院心内科2016年2月至2018年3月行环肺静脉前庭射频消融术(CPVA)的163例心房颤动患者的临床资料,全部患者均于消融术后6个月行LGE-CMR检查,采用心脏分析软件(Medis QMASS 4.2)获得术后左心房容积(LAV)及左心房心肌瘢痕质量百分比(LA-LGE%);按照术后随访有无复发心房颤动分为复发组和无复发组,比较两组各指标与心房颤动复发的相关性。结果复发组的LAV较无复发组的LAV显著增大[(97.5±12.8)ml vs.(70.5±11.7)ml,P<0.05];无复发组的LA-LGE%高于复发组[(23.3±8.5)%vs.(17.5±5.6)%,P<0.05],差异均有统计学意义。多因素Logisitic分析显示:LAV(OR=1.34,P<0.01)和LA-LGE%(OR=0.71,P=0.02)可作为CPVA术后复发的影响因素。结论LA-LGE%程度高的CPVA患者术后的心房颤动复发率相对较低;LAV增加和LA-LGE%程度低是影响心房颤动射频消融术后复发的高危因素。Objective To explore and analyze the value of quantitative evaluation using late gadolinium enhancement cardiac magnetic resonance imaging(LGE-CMR)in assessing the extent of left atrial myocardial scarring after circumferential pulmonary vein ablation(CPVA)for atrial fibrillation.Methods The clinical data of 163 atrial fibrillation patients who underwent CPVA in the Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,from February 2016 to March 2018 were retrospectively analyzed.All patients underwent LGE-CMR examination 6 months after CPVA.The left atrial volume(LAV)and the percentage of left atrial myocardial scar(LA-LGE%)were obtained using cardiac analysis software(Medis QMASS 4.2).The correlation between the measured indicators and atrial fibrillation recurrence was compared between the two groups.Results The recurrence group had a significantly larger LAV compared to the non-recurrence group[(97.5±12.8)ml vs.(70.5±11.7)ml,P<0.05],while the LA-LGE%in the non-recurrence group was higher than that in the recurrence group[(23.3±8.5)%vs.(17.5±5.6)%,P<0.05],both with statistically significant differences.Multivariate logistic analysis showed that LAV(OR=1.34,P<0.01)and LA-LGE%(OR=0.71,P=0.02)were influencing factors for recurrence after CPVA.Conclusion Patients with a higher LA-LGE%have a relatively lower recurrence rate after CPVA.Increased LAV and low LA-LGE%are high-risk factors for recurrence of atrial fibrillation after CPVA.

关 键 词：心房颤动 左心房容积 心脏延迟增强磁共振 心肌瘢痕 

分 类 号：R541.75[医药卫生—心血管疾病] R445.2[医药卫生—内科学]