磁共振对梗阻性肥厚型心肌病室间隔心肌消融术疗效的预测价值

Role of cardiac magnetic resonance on predicting outcome in patients with hypertrophic obstructive cardiomyopathy undergoing percutaneous transluminal septal myocardial ablation

目的 探讨磁共振对梗阻性肥厚型心肌病室间隔心肌消融术疗效的预测价值.方法 从2010年3月至2012年9月,连续入选阜外心血管病医院的经皮穿刺腔内间隔心肌消融术（PTSMA）患者38例进行回顾性分析.患者在术前均行心脏磁共振检查.术后半年检查超声心动图,左心室流出道压差（LVOTG）＜ 30 mmHg（1 mmHg=0.133 kPa）为治疗有效.分析磁共振参数与PTSMA疗效之间的关系,并采用受试者工作特征（ROC）曲线评价磁共振参数的预测效能.结果 PTSMA的治疗有效率为65.8％ （25/38）.Pearson相关分析显示,磁共振测量的左心室前壁基底段厚度（r =0.505,P=0.001）、前间隔基底段厚度（r=0.500,P=0.001）以及两者之和（r=0.656,P＜0.001）与LVOTG呈正相关.ROC曲线显示,左心室前壁基底段厚度、前间隔基底段厚度以及两者之和的曲线下面积分别为0.806、0.675和0.834;左心室前壁基底段和前间隔基底段厚度之和为49.6 mm时,预测PTSMA治疗有效的敏感度和特异度分别为84.6％和84.0％.结论 梗阻性肥厚型心肌病患者LVOTG与前壁基底段、前间隔基底段室壁厚度有关,两者之和可以更好地预测PTSMA的疗效.

Objective To investigate the predictive value of cardiac magnetic resonance （CMR） on outcome of patients with hypertrophic obstructive cardiomyopathy （HOCM） undergoing percutaneous transluminal septal myocardial ablation （PTSMA）.Methods A total of 38 consecutive HOCM patients underwent CMR imaging before PTSMA in Fuwai hospital From March 2010 to September 2012 were included in this retrospective study.The efficacy was defined as ＞ 30 mmHg（1 mmHg =0.133 kPa）reduction of echocardiography derived left ventricular outflow tract gradient （LVOTG） at 6 months post operation.The relationship between CMR imaging derived parameters and effect of PTSMA was analyzed.Receiver operating curve （ROC） was applied to assess the predicting effectiveness of related CMR parameters.Results The effective rate of PTSMA was 65.8％ （25/38）.The thickness of basal anterior wall（r =0.505,P =0.001）,basal anteroseptal wall （0.500,P =0.001） and the sum of the two segments （r =0.656,P ＜ 0.001）was positively correlated to the post-procedure reduction of LVOTG.The area under the ROC curve of the thickness of basal anterior wall,basal anteroseptal wall and the sum of the two segments was 0.806,0.675 and 0.834,respectively.The sensitivity was 84.6％ and specificity was 84.0％ to predict the efficacy of PTSMA using the sum of left ventricular basal anterior wall and basal anteroseptal wall thickness 49.6 mm as cut-off value.Conclusions LVOTG reduction post PTSMA positively correlates to pre-procedure left ventricular basal anterior wall,basal anteroseptal wall and the total thickness of these two segments in patients with HOCM.The total thickness of these two segments is a superior parameter for predicting efficacy of PTSMA in HOCM patients.