心脏磁共振对原发扩张性心肌病左心整体功能和心肌纤维化的应用研究
|
摘要
目的探讨1.5T心脏磁共振研究原发扩张性心肌病(dilated cardiomyopathy,DCM)左心整体功能和心肌纤维化(myocardial fibrosis,MF)的应用价值。方法选择2016年6月—2018年6月安徽医科大学第二附属医院心内科收治的DCM患者27例,另收集同期健康志愿者27例。所有入组均行1.5T心脏磁共振常规平扫及钆剂增强检查,获取左心室短轴电影(平扫)和心脏磁共振延迟增强(DE-MRI)图像。分别得出2组各项左心室功能指标(对部分指标体表面积标准化)及心肌延迟强化图像,功能指标包括:左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室心肌质量(LVMM)、左心室射血分数(LVEF)、左心室高峰射血率(LVPER)、左心室高峰充盈率(LVPFR)及室间隔厚径(IVSTD)等,并比较2组之间各项数值的差异。DCM组内根据是否延迟强化分成DE-MRI(+)组和DE-MRI(-)组,并比较组间各项指标差异。结果①患者组的LVEF、LVPER、LVPFR、IVSTD低于健康对照组,余指标明显高于健康对照组,且差异均具有统计学意义;②DE-MRI(+)组LVMM、LVESV高于DE-MRI(-)组,而DE-MRI(+)组LVEF减低,且差异均具有统计学意义,其余组间差异无统计学意义。③扩心病17例(62.96%)均出现心肌延迟强化,共计153个节段出现延迟强化,肌壁间101个节段(66.01%)强化特点显著,分布部位以室间隔壁[12例(70.58%)]为主。结论①DCM的左室整体功能减低同时多伴有左室心肌纤维化,并以室间隔肌壁间分布显著;②LVMM可以大致评估DCM心肌纤维化(MF)程度。
Objective To investigate the value of 1.5 T cardiac magnetic resonance imaging in the study of left ventricular global function and myocardial fibrosis in primary dilated cardiomyopathy(DCM). Methods Selected Twenty seven patients were admitted to the Department of Radiology, the Second Affiliated Hospital of Anhui Medical University from June 2016 to June 2018 with dilated cardiomyopathy(DCM) and 27 healthy volunteers were collected. All subjects were examined with conventional 1.5 T cardiac magnetic resonance plain scan and gadolinium enhancement. Left ventricular short axis film(plain scan) and delayed enhanced cardiac magnetic resonance images(DE-MRI) were obtained. The left ventricular function indices(standardized body surface area) and myocardial delayed enhancement images were obtained. The functional indices included left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular myocardial mass(LVMM), left ventricular ejection fraction(LVEF), and left ventricular peak ejection rate(LVPER), left ventricular peak filling rate(LVPFR) and interventricular septal thickness(IVSTD), etc. The differences of values between the two groups were compared. In DCM group, the above values were divided into DE-MRI(+) group and DE-MRI(-) group according to delayed enhancement, and the differences between the two groups were compared. Results ①The LVEF, LVPER, LVPFR and IVSTD of the patients group were lower than those of the healthy control group, and the remaining indicators were significantly higher than those of the healthy control group, with statistical significance; ②The LVMM and LVESV of DE-MRI(+) group were higher than those of DE-MRI(-) group, while LVEF decreased in DE-MRI(+) group, with statistical significance. There was no difference among the other groups. ③Delayed myocardial enhancement was found in 17 patients(62.96%) with 153 segments, including 101 segments(66.01%) between the muscles, and the ventricular septal wall(12 cases, 70.58%) were the main sites. Conclusion ①Decreased global left ventricular function in DCM is accompanied by left ventricular myocardial fibrosis, and the distribution of septal wall is significant. ②LVMM can roughly evaluate the degree of myocardial fibrosis(MF) in DCM.
Objective To investigate the value of 1.5 T cardiac magnetic resonance imaging in the study of left ventricular global function and myocardial fibrosis in primary dilated cardiomyopathy(DCM). Methods Selected Twenty seven patients were admitted to the Department of Radiology, the Second Affiliated Hospital of Anhui Medical University from June 2016 to June 2018 with dilated cardiomyopathy(DCM) and 27 healthy volunteers were collected. All subjects were examined with conventional 1.5 T cardiac magnetic resonance plain scan and gadolinium enhancement. Left ventricular short axis film(plain scan) and delayed enhanced cardiac magnetic resonance images(DE-MRI) were obtained. The left ventricular function indices(standardized body surface area) and myocardial delayed enhancement images were obtained. The functional indices included left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular myocardial mass(LVMM), left ventricular ejection fraction(LVEF), and left ventricular peak ejection rate(LVPER), left ventricular peak filling rate(LVPFR) and interventricular septal thickness(IVSTD), etc. The differences of values between the two groups were compared. In DCM group, the above values were divided into DE-MRI(+) group and DE-MRI(-) group according to delayed enhancement, and the differences between the two groups were compared. Results ①The LVEF, LVPER, LVPFR and IVSTD of the patients group were lower than those of the healthy control group, and the remaining indicators were significantly higher than those of the healthy control group, with statistical significance; ②The LVMM and LVESV of DE-MRI(+) group were higher than those of DE-MRI(-) group, while LVEF decreased in DE-MRI(+) group, with statistical significance. There was no difference among the other groups. ③Delayed myocardial enhancement was found in 17 patients(62.96%) with 153 segments, including 101 segments(66.01%) between the muscles, and the ventricular septal wall(12 cases, 70.58%) were the main sites. Conclusion ①Decreased global left ventricular function in DCM is accompanied by left ventricular myocardial fibrosis, and the distribution of septal wall is significant. ②LVMM can roughly evaluate the degree of myocardial fibrosis(MF) in DCM.
引文
[1] 慕家盛,陈启稚.心脏磁共振诊断非缺血性心肌纤维化中的应用进展[J].临床心血管病杂志,2018,34(1):91-95.
[2] 赵世华.心血管病磁共振诊断学[M].北京:人民军医出版社,2011.
[3] THAVENDIRANATHAN P,WALLS M,GIRI S,et al.Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping[J].Circ Cardiovasc Imaging,2012,5(1):102-110.
[4] RAUHALAMMI S M O,KENNETH M,HALL B P,et al.Native myocardial longitudinal (T1) relaxation time:Regional,age,and sex associations in the healthy adult heart[J].J Magn Reson Imaging,2016,44(3):541-548.
[5] PUNTMANN V O,PEKER E,CHANDRASHEKHAR Y,et al.T1 mapping in characterizing myocardial disease:a comprehensive review[J].Circ Res,2016,119(2):277.
[6] BHATIA M.Evaluation of ischemic heart disease and viability by cardiac MRI[J].Indian Heart J,2014,66(1):143-144.
[7] 陈晓荣,胡红杰,钱玉娥,等.心脏MR评价肥厚型心肌病左心房功能的应用研究[J].医学影像学杂志,2014,24(9):1482-1486.
[8] 陈伟,张如志,夏睿,等.心血管磁共振评估急性心肌梗死可挽救心肌的研究进展[J].中国医学影像技术,2015,31(2):314-318.
[9] NORDENSKJ?LD A M,HAMMAR P,AHLSTR?M H,et al.Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging-prognostic implications[J].PLoS One,2016,11(2):e0148803.
[10] WENG Z,YAO J,CHAN R H,et al.Prognostic value of LGE-CMR in HCM:A Meta-Analysis[J].JACC Cardiovasc Imaging,2016,18(S1):P117.
[11] FU L,XU Y,LING T,et al.Oxymatrine inhibits aldosterone-induced rat cardiac fibroblast proliferation and differentiation by attenuating smad-2,-3 and-4 expression:an in vitro study[J].BMC Complement Altern Med,2016,16(1):241.
[12] 蒋洪强,张金国.黄芪甲苷抑制慢性心力衰竭大鼠心肌纤维化和转化生长因子β1的表达[J].新医学,2016,47(1):27-33.
[13] TSENG W Y,SU M Y,TSENG Y H.Introduction to cardiovascular magnetic resonance:technical principles and clinical applications[J].Acta Cardiol Sin,2016,32(2):129-144.
[14] 陈刘婷,姜洪.心脏磁共振在心肌病中的应用进展[J].中华临床医师杂志(电子版),2012,6(16):4814-4815.
[15] MORAES G L,HIGGINS C B,ORDOVAS K G.Delayed enhancement magnetic resonance imaging in nonischemic myocardial disease[J].J Thorac Imaging,2013,28(2):84-92.
[16] RODRíGUEZ-GRANILLO G A,MEJíA-CAMPILLO M,ROSALES M A,et al.Left ventricular filling patterns in patients with previous myocardial infarction measured by conventional cine cardiac magnetic resonance[J].Int J Cardiovasc Imaging,2012,28(4):795-801.
[17] MORAVSKY G,OFEK E,RAKOWSKI H,et al.Myocardial fibrosis in hypertrophic cardiomyopathy:accurate reflection of histopathological findings by CMR[J].JACC Cardiovasc Imaging,2013,6(5):587-596.
[18] OLIVOTTO I,MARON M S,AUTORE C,et al.Assessment and significance of left ventricular mass by cardiovascular magnetic resonance in hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2008,52(7):559-566.
[19] ALTER P,RUPP H,ADAMS P,et al.Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy[J].Eur J Heart Fail,2014,13(9):937-944.
[2] 赵世华.心血管病磁共振诊断学[M].北京:人民军医出版社,2011.
[3] THAVENDIRANATHAN P,WALLS M,GIRI S,et al.Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping[J].Circ Cardiovasc Imaging,2012,5(1):102-110.
[4] RAUHALAMMI S M O,KENNETH M,HALL B P,et al.Native myocardial longitudinal (T1) relaxation time:Regional,age,and sex associations in the healthy adult heart[J].J Magn Reson Imaging,2016,44(3):541-548.
[5] PUNTMANN V O,PEKER E,CHANDRASHEKHAR Y,et al.T1 mapping in characterizing myocardial disease:a comprehensive review[J].Circ Res,2016,119(2):277.
[6] BHATIA M.Evaluation of ischemic heart disease and viability by cardiac MRI[J].Indian Heart J,2014,66(1):143-144.
[7] 陈晓荣,胡红杰,钱玉娥,等.心脏MR评价肥厚型心肌病左心房功能的应用研究[J].医学影像学杂志,2014,24(9):1482-1486.
[8] 陈伟,张如志,夏睿,等.心血管磁共振评估急性心肌梗死可挽救心肌的研究进展[J].中国医学影像技术,2015,31(2):314-318.
[9] NORDENSKJ?LD A M,HAMMAR P,AHLSTR?M H,et al.Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging-prognostic implications[J].PLoS One,2016,11(2):e0148803.
[10] WENG Z,YAO J,CHAN R H,et al.Prognostic value of LGE-CMR in HCM:A Meta-Analysis[J].JACC Cardiovasc Imaging,2016,18(S1):P117.
[11] FU L,XU Y,LING T,et al.Oxymatrine inhibits aldosterone-induced rat cardiac fibroblast proliferation and differentiation by attenuating smad-2,-3 and-4 expression:an in vitro study[J].BMC Complement Altern Med,2016,16(1):241.
[12] 蒋洪强,张金国.黄芪甲苷抑制慢性心力衰竭大鼠心肌纤维化和转化生长因子β1的表达[J].新医学,2016,47(1):27-33.
[13] TSENG W Y,SU M Y,TSENG Y H.Introduction to cardiovascular magnetic resonance:technical principles and clinical applications[J].Acta Cardiol Sin,2016,32(2):129-144.
[14] 陈刘婷,姜洪.心脏磁共振在心肌病中的应用进展[J].中华临床医师杂志(电子版),2012,6(16):4814-4815.
[15] MORAES G L,HIGGINS C B,ORDOVAS K G.Delayed enhancement magnetic resonance imaging in nonischemic myocardial disease[J].J Thorac Imaging,2013,28(2):84-92.
[16] RODRíGUEZ-GRANILLO G A,MEJíA-CAMPILLO M,ROSALES M A,et al.Left ventricular filling patterns in patients with previous myocardial infarction measured by conventional cine cardiac magnetic resonance[J].Int J Cardiovasc Imaging,2012,28(4):795-801.
[17] MORAVSKY G,OFEK E,RAKOWSKI H,et al.Myocardial fibrosis in hypertrophic cardiomyopathy:accurate reflection of histopathological findings by CMR[J].JACC Cardiovasc Imaging,2013,6(5):587-596.
[18] OLIVOTTO I,MARON M S,AUTORE C,et al.Assessment and significance of left ventricular mass by cardiovascular magnetic resonance in hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2008,52(7):559-566.
[19] ALTER P,RUPP H,ADAMS P,et al.Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy[J].Eur J Heart Fail,2014,13(9):937-944.