T1-mapping和ECV在诊断肥厚型心肌病和H型高血压心室肥厚中的临床价值

The Value of T1-mapping and ECV in the Diagnosis of Hypertrophic Cardiomyopathy and H-type Hypertensive Ventricular Hypertrophy

探讨心脏磁共振T1-mapping成像与细胞外容积ECV(extra cellular volume,ECV)在肥厚型心肌病(hypertrophic cardiomyopathy,HCM)和H型高血压心室肥厚中的的诊断价值.选取2017年1月—2019年12月期间,于云南省第一人民医院就诊并在磁共振科行心脏MRI检查的42名患者,其中H型高血压16例,肥厚型心肌病26例.所有患者均行心脏形态学、T1-mapping及钆对比剂增强扫描,比较两组患者的左心室质量(LVM)、左室射血分数(LVEF)、心率(HR)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVEDI)和每搏输出量;并将两组患者按照是否出现延迟强化(Late gadolinium enhancement,LGE)将其分为LGE组和非LGE组,分别测量增强前后T1、T1-mapping及ECV值.H型高血压患者收缩压、舒张压及左心室质量高于肥厚型心肌病患者(P<0.05),射血分数、每搏输出量和心室厚度低于肥厚型心肌病患者(P<0.05),而年龄、性别、心率和肌酐等基础参数无统计学差异.H型高血压和肥厚型心肌病患者中分别有8例和18例出现心肌延迟强化,肥厚型心肌病患者的Native T1、T1和ECV明显升高(P<0.05);H型高血压和肥厚型心肌病患者非LGE组T1和ECV值显著低于LGC组(P<0.05),而在LGE组中,H型高血压患者ECV指标显著低于肥厚型心肌病患者(P<0.05).ROC曲线分析,Native T1和T1鉴别两者时的曲线下面积(AUC)分别为0.721和0.803,灵敏度为0.692和0.769,特异度为0.875和0.750;ECV在鉴别两者时的曲线下面积(AUC)为0.808,灵敏度为0.615,特异度为1.000.T1-mapping和ECV在鉴别H型高血压心室肥厚和肥厚型心肌病时具有重要的价值,尤其是ECV在鉴别诊断上有较高效能.

This paper investigates the diagnostic value of cardiac magnetic resonance T1-mapping imaging and extracellular volume(ECV)in hypertrophic cardiomyopathy(HCM)and H-type hypertensive ventricular hypertrophy.The samples are 42 patients who were treated in the first people’s Hospital of Yunnan Province and underwent cardiac MRI examination in the Department of Magnetic Resonance from January 2017 to December 2019,including 16 patients with H-type hypertension and 26 patients with hypertrophic cardiomyopathy.Left ventricular mass(LVM),left ventricular ejection fraction(LVEF),heart rate(HR),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVEDI)and stroke volume were compared between the two groups.According to the presence of delayed enhanced(LGE),the patients in the two groups were divided into LGE group and non-LGE group,and the values of T1,T1-mapping and ECV were measured before and after enhancement.There was no significant difference in age,sex,heart rate,creatinine and other basic parameters between patients with H-type hypertension and patients with hypertrophic cardiomyopathy,but there were significant differences in systolic blood pressure,diastolic blood pressure and left ventricular mass(P<0.05).Ejection fraction,stroke volume and ventricular thickness were lower than those in hypertrophic cardiomyopathy(P<0.05).Delayed enhancement of myocardium was found in 8 patients with H-type hypertension and 18 patients with hypertrophic cardiomyopathy,Native T1,T1 and ECV in hypertrophic cardiomyopathy were significantly increased,T1 and ECV in patients with H-type hypertension and non-LGE cardiomyopathy were significantly lower than those in LGC group,while ECV in patients with H-type hypertension was significantly lower than that in patients with hypertrophic cardiomyopathy in LGE group.ROC curve analysis showed that the area under the curve of Native T1 and T1 was 0.721 and 0.803,the sensitivity was 0.692 and 0.769,the specificity was 0.875 and 0.750,the area under the curve(AUC)was 0.808,the sensitivity was 0.615 and the specificity was 1.000.T1-mapping and ECV are of great value in the differential diagnosis of H-type hypertensive ventricular hypertrophy and hypertrophic cardiomyopathy,and ECV is highly efficient in differential diagnosis.