基于心脏磁共振探究扩张型心肌病患者经标准化抗心力衰竭药物治疗后左心室逆重构的预测因素  

Predictors of left ventricular reverse remodeling in dilated cardiomyopathy patients after standard heart failure therapy:insights from cardiac magnetic resonance imaging

作　　者：刘涛[1] 高晓坤 范茜寒 郭沛宏 吴灵教 杞天付 赵卫[1] 王钰[2] 陈伟[1] Liu Tao;Gao Xiaokun;Fan Xihan;Guo Peihong;Wu Lingjiao;Qi Tianfu;Zhao Wei;Wang Yu;Chen Wei(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Ultrasound,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,650032 [2]昆明医科大学第一附属医院超声科,650032

出　　处：《中国心血管杂志》2025年第1期35-44,共10页Chinese Journal of Cardiovascular Medicine

基　　金：云南省科技厅基础研究计划项目(202301AY070001-054);云南省放射与治疗临床医学研究中心项目(202102AA10006)。

摘　　要：目的基于心脏磁共振(CMR)定量评价心肌纤维化,探索扩张型心肌病(DCM)患者经标准化抗心力衰竭(心衰)药物治疗后左心室逆重构(LVRR)的CMR预测指标。方法临床回顾性研究。连续纳入2020年9月至2023年7月昆明医科大学第一附属医院DCM患者48例,其中男性32例(66.7%);并选取同期年龄、性别相匹配的健康成人40名作为对照组,其中男性27名(67.5%)。所有DCM患者接受标准化抗心衰药物治疗,并于基线行CMR检查,于基线和随访时行超声心动图检查。CMR检查:(1)电影序列,评价心功能,包括左心室舒张末期容积指数(LVEDVi)、左心室收缩末期容积指数(LVESVi)、左心室心肌质量指数(LVMMi)、左心室射血分数(LVEF)、左心室整体纵向应变(GLS)、整体径向应变(GRS)和整体周向应变(GCS);(2)T1 mapping技术,评价心肌弥漫性纤维化,包括native T1值、细胞外容积分数(ECV);(3)钆延迟强化(LGE)技术,评价心肌替代性纤维化,以LGE占左心室心肌质量百分比(%LV)表示。超声心动图检查指标包括LVEF和左心室舒张末期内径指数(LVEDDi)。根据基线和随访时的LVEF和LVEDDi,将DCM患者分为LVRR(+)组和LVRR(-)组。采用单因素和多因素logistic回归分析筛选DCM患者发生LVRR的预测因素。绘制受试者工作特征(ROC)曲线分析CMR参数对LVRR的预测效能。结果中位随访时间为10.5(6,15.8)个月。DCM患者14例(29.2%)发生LVRR。与对照组相比,DCM组患者的体质指数和心率较高,吸烟、酗酒和高血脂病史比例较高,LVEDVi、LVESVi、LVMMi、native T1值和ECV明显升高,GLS、GRS、GCS和LVEF明显降低,差异均有统计学意义(均为P<0.05)。与LVRR(-)组比较,LVRR(+)组的基线LVEF无统计学差异(P=0.526),随访时LVEF明显升高、LVEDD明显降低(均为P<0.001)。DCM患者基线时CMR检查均存在左心室心肌LGE。与LVRR(-)组比较,LVRR(+)组的基线B型利钠肽[384.4(76.7,536.5)pg/ml比760.6(310.7,1067.6)pg/ml]、LVEDVi[145.8(110.9,157.3)mlObjective To quantitatively assess myocardial fibrosis using cardiac magnetic resonance(CMR)and to explore CMR predictors of left ventricular reverse remodeling(LVRR)in patients with dilated cardiomyopathy(DCM)following standardized heart failure(HF)pharmacological treatment.Methods This was a retrospective study,which consecutively included 48 patients(32 males)with DCM from September 2020 to July 2023 at the First Affiliated Hospital of Kunming Medical University.A control group of 40 healthy adults(27 males),matched for age and gender,was selected from the same period.All DCM patients received standardized HF pharmacological treatment and underwent baseline CMR examination.Echocardiographic assessments were performed at baseline and during follow-up.CMR examination:(1)Cine sequences were used to evaluate cardiac function,including left ventricular end-diastolic volume index(LVEDVi),left ventricular end-systolic volume index(LVESVi),left ventricular myocardial mass index(LVMMi),left ventricular ejection fraction(LVEF),global longitudinal strain(GLS),global radial strain(GRS),and global circumferential strain(GCS).(2)T1 mapping techniques were employed to assess myocardial diffuse fibrosis,including native T1 values and extracellular volume fraction(ECV).(3)Late gadolinium enhancement(LGE)technique was used to evaluate myocardial replacement fibrosis,expressed as the percentage of LGE in left ventricular myocardial mass(%LV).Echocardiographic assessment included LVEF and left ventricular end-diastolic diameter index(LVEDDi).Based on the LVEF and LVEDDi at baseline and follow-up,DCM patients were divided into the LVRR(+)group and LVRR(-)group.Univariate and multivariate logistic regression analyses were performed to identify predictive factors for LVRR in DCM patients.Receiver operating characteristic(ROC)curves were plotted to assess the predictive performance of CMR parameters for LVRR.Results The median follow-up duration was 10.5(6,15.8)months.A total of 14 DCM patients(29.2%)experienced LVRR.Compared to the

关 键 词：扩张型心肌病 心力衰竭 心肌纤维化 左心室逆重构 磁共振成像 钆延迟强化 定量分析 

分 类 号：R54[医药卫生—心血管疾病]