心脏核磁共振在室性心律失常诊治中的应用价值

Application value of cardiac magnetic resonance imaging(CMR) in diagnosis and treatment of ventricular arrhythmia

目的评价心脏核磁共振(CMR)在室性心律失常诊治中的应用价值。方法以自2016年1月—2017年11月确诊并接受治疗的45例室性心律失常患者为研究对象,所有研究对象均经心脏核磁共振检查,对图像进行首过灌注和延迟扫描分析(LEG),观察其在心脏结构和心肌缺血的检测信息,记录其左室舒张末期内径、左心室收缩面积、左心室室间隔厚度、左室后壁厚度、左室射血分数和右室射血分数等心脏功能检测参数,并将检查结果与超声心动图(UCG)、冠脉造影(CAG)的检查结果进行比较分析。结果 CMR测得的左室舒张末期内径、左心室收缩面积、左心室室间隔厚度、左室后壁厚度、左室射血分数、右室射血分数与UCG的测量结果均呈正相关(r=0.782、0.811、0.743、0.822、0.774、0.830,P<0.05),在左心室结构及功能评价方面,两者差异无统计学意义(P>0.05);同时,CMR共检出10例右心室扩大和16例右室收缩功能不全病例,而UCG均未检出相关类型病例。在冠脉不同病变范围情况下,CMR与UCG对心肌缺血的检测性能差异无统计学意义(P>0.05),但在冠脉不同程度狭窄程度下,CMR对心肌缺血的检出率高于UCG。结论 CMR检测对室性心律失常患者右心室生理结构病变的鉴别能力更强,对冠脉不同程度狭窄情况下心肌缺血状况的检出率更高,在室性心律失常诊断与治疗中具有较高应用价值,值得临床推广使用。

Objective To evaluate the value of cardiac magnetic resonance imaging(CMR) in the diagnosis and treatment of ventricular arrhythmia.Methods Total 45 patients with ventricular arrhythmias from January 2016 to January2017 were selected as subjects.All subjects underwent first pass perfusion and delayed scan analysis(LEG) to record the information of cardiac structure,cardiac function and myocardial ischemia.The left ventricular end diastolic diameter,left ventricular systolic area,left ventricular septal thickness,left ventricular posterior wall thickness,left ventricular ejection fraction and right ventricular ejection fraction were recorded.The results were compared with those of echocardiography(UCG) and coronary angiography(CAG).Results Left ventricular end-diastolic diameter,left ventricular systolic area,left ventricular septal thickness,left ventricular posterior wall thickness,left ventricular ejection fraction and right ventricular ejection fraction measured by CMR were positively correlated with UCG.There was no significant difference in left ventricular structure and function evaluation between the two groups(P > 0.05).There were 10 cases of right ventricular enlargement and 16 cases of right ventricular systolic dysfunction,while none of the UCG cases were detected.There was no significant difference in the detection of myocardial ischemia between CMR and UCG in different coronary lesions(P > 0.05),but the detection rate of myocardial ischemia by CMR was higher than that by UCG in different degree of coronary stenosis.Conclusion CMR has a stronger ability to differentiate the right ventricular physiological structure lesions in patients with ventricular arrhythmia,and has a higher detection rate of myocardial ischemia in patients with different degree of coronary artery stenosis.CMR has a higher application value in the diagnosis and treatment of ventricular arrhythmia,and is worthy of clinical application.