扩张型心肌病左室重构与心率变异性、室性心律失常的相关性:基于心脏磁共振  

Correlation between left ventricular remodeling and heart rate variability,ventricular arrhythmia in dilated cardiomyopathy:based on cardiac magnetic resonance

作　　者：胡斯茵 何振多 杜勇兴 林晓鑫 欧阳裕锋 黄裕立 陈海雄 HU Siyin;HE Zhenduo;DU Yongxing;LIN Xiaoxin;OUYANG Yufeng;HUANG Yuli;CHEN Haixiong(Department of Radiology,Shunde Hospital,Southern Medical University,Foshan 528300,China;Department of Cardiovascular Medicine,Shunde Hospital,Southern Medical University,Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院放射科,广东佛山528300 [2]南方医科大学顺德医院心血管内科,广东佛山528300

出　　处：《分子影像学杂志》2025年第2期173-179,共7页Journal of Molecular Imaging

基　　金：广东省科技厅粤佛联合基金重点项目(2019B1515120044);广东省中医药局科研项目(20251375);佛山市杰出青年医学人才项目(360290)。

摘　　要：目的探讨扩张型心肌病(DCM)患者左室重构参数与心率变异性(HRV)及室性心律失常(VA)的相关性。方法回顾性收集2019年7月~2024年3月于南方医科大学顺德医院确诊的扩张型心肌病患者44例及同期健康者23例的临床资料、心脏磁共振(CMR)及24 h动态心电图数据,分析其左室重构指标、心肌纤维化程度及HRV指标差异。左室重构指标包括左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室每搏输出量指数(LVSVI)、心指数(CI)、左心室心肌质量指数(LVMMI)。HRV指标包括NN间期标准差(SDNN)、5 min NN间期标准差(SDANN)、相邻NN间期差值平方均值的平方根(rMSSD)、相邻NN间期差值大于50 ms的数目占总NN间期数的比例(pNN50)、低频功率(LF)、高频功率(HF)、低频功率与高频功率比值(LF/HF)。根据SDNN≥100及SDNN<100,将DCM患者分为HRV正常亚组及HRV降低亚组,比较两亚组之间左室重构指标的差异。根据室性早搏Lown分级分为低危VA亚组及高危VA亚组,探讨发生高危VA的相关危险因素。结果DCM组的LVEF、LVSVI、CI低于对照组,LVEDVI、LVESVI和LVMMI高于对照组,DCM组91%出现心肌纤维化,HRV指标中DCM组的SDNN、SDANN、LF、HF、LF/HF低于对照组(P<0.05)。在HRV降低亚组中,LVEF低于HRV正常亚组,LVESVI、LVMMI则高于HRV正常亚组(P<0.05)。与低危VA亚组相比,高危VA亚组心肌纤维化程度更严重(P<0.05)。Logistic回归分析表明心肌纤维化程度是高危VA发生的独立危险因素。结论DCM患者出现左室重构,HRV不同程度降低,其左室重构和自主神经功能受损具有相关性,心肌纤维化程度是发生高危VA的独立危险因素;CMR检查有助于风险分层,为早期干预及治疗提供依据。Objective To investigate the correlation between left ventricular remodeling parameters and heart rate variability(HRV),as well as the correlation between left ventricular remodeling parameters and ventricular arrhythmia(VA)in patients with dilated cardiomyopathy(DCM).Methods Clinical data,cardiac magnetic resonance(CMR)data and 24 h dynamic electrocardiogram data were collected from 44 patients diagnosed with dilated cardiomyopathy at Shunde Hospital of Southern Medical University from July 2019 to March 2024 as well as 23 healthy controls.Left ventricular remodeling parameters,degree of myocardial fibrosis,and HRV indicators of two groups were obtained and the differences of those parameters between two groups were analyzed.Left ventricular remodeling parameters included left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),left ventricular stroke volume index(LVSVI),cardiac index(CI),and left ventricular myocardial mass index(LVMMI).HRV indicat ors included standard deviation of all NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min se gments(SDANN),the square root of the mean of the sum of the squares of differences between adjacent NN intervals(rMSSD),the proportion of interval differences with successive NN intervals greater than 50 ms to all NN interval differences(pNN50),low frequency power(LF),high frequency power(HF),and low frequency power to high frequency power ratio(LF/HF).DCM patients were classified into normal HRV(SDNN≥100)and reduced HRV(SDNN<100)subgroups to compare the differences of left ventricular remodeling indicators.Additionally,based on the Lown classification of premature ventricular contractions,DCM patients were divided into low-risk VA and high-risk VA subgroups to explore related risk factors for the occurrence of high-risk VA.Results The DCM group had significantly lower LVEF,LVSVI and CI compared to controls,while LVEDVI,LVESVI and LVMMI were higher,with 91%

关 键 词：扩张型心肌病 左室重构 心肌纤维化 室性心律失常 心率变异性 

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