围产期心肌病与特发性扩张型心肌病的MRI比较研究

Comparative study of peripartum cardiomyopathy and idiopathic dilated cardiomyopathy MRI

目的：研究围产期心肌病（PPCM）与特发性扩张型心肌病（IDCM）的心脏MR（CMR）特征，探讨MRI对PPCM的诊断价值。方法回顾性搜集临床明确诊断为PPCM（PPCM组）及IDCM （IDCM组）的患者各10例。所有患者均采用1.5 T MRI扫描仪对心脏形态（房室大小、小梁化程度、最薄心室壁厚度）、功能（室壁局部运动与整体运动功能）、心肌灌注与心肌纤维化等方面进行综合评价，主要评价指标有心输出量（CO）、舒张末期容积（EDV）、射血分数（EF）、收缩末期容积（ESV）、每搏输出量（SV）等。采用独立样本t检验及Fisher精确概率法进行统计学分析。结果 PPCM与IDCM组的房室大小、CO、EDV、EF、ESV、SV差异均无统计学意义（P值均〉0.05）。CMR检查均提示心室壁变薄，4例PPCM及3例IDCM左室心尖部可见过度小梁化。7例PPCM及4例IDCM出现单纯性收缩运动减弱，3例PPCM及6例IDCM出现双室的收缩运动减弱。2例PPCM出现小灶状延迟强化，4例IDCM出现肌壁间延迟强化。1年后随访10例PPCM及4例IDCM心功能恢复正常。结论 MRI多序列成像是PPCM较为理想的影像检查方法，PPCM与IDCM患者在心脏形态结构、功能无明显差异，但PPCM的预后较IDCM好。

Objective To characterize the cardiac magnetic resonance （CMR） features of peripartum cardiomyopathy（PPCM） and idiopathic dilated cardiomyopathy（IDCM）, and to explore the value of MRI in the diagnosis of PPCM. Methods Ten cases of PPCM and 10 cases of Idiopathic dilated cardiomyopathy （IDCM） were included in this study. With 1.5 T MRI scanner, the heart shape （atrioventricular size, hypertrabeculation, thickness of the thinnest ventricular wall）, function （ventricular wall movement and the overall function）, cardiomyopathy perfusion were comprehensively evaluated. Paired samples t-test and Fisher exact probability method were used for statistical analysis. Results Between PPCM and IDCM group, there was no statistical significant difference in the atrioventricular size, cardiac output（CO）, end diastolic volume（EDV）, ejection fraction （EF）, end systolic volume （ESV） and stroke volume （SV） （P〉0.05）. IDCM and PPCM group both showed ventricular wall thinning on MRI, with 4 cases of PPCM and 3 cases of IDCM presenting hypertrabeculation in the left ventricular apex. Seven cases of PPCM and 4 cases of IDCM depicted left ventricular local dysfunction, while 3 cases of PPCM and 6 cases of IDCM had abnormal integral movement. Two cases of PPCM appeared local delayed enhancement, while 4 cases of＆amp;nbsp;IDCM showed intramural delayed enhancement. After one year of follow-up, heart function recovered in 10 cases of PPCM and 4 cases of IDCM. Conclusions MRI diagnosis using multiple sequences is an ideal method in the evaluation of PPCM. Although there were no differences in cardiac morphology and function between PPCM and IDCM, the prognosis of PPCM is better than IDCM.