延迟增强磁共振显像对房颤患者外科消融预后的评估价值

Clinical value of delayed enhancement MRI in evaluating the prognosis of surgical ablation in patients with atrial fibrillation

目的 比较延迟增强磁共振（DE-MRI）与病理组织学方法检测心房纤维化程度的相关性,并分析其对房颤患者外科消融预后的评估价值.方法 2013年10月至2015年12月间,43例心脏瓣膜病合并房颤拟同期行房颤消融手术的患者,术前行DE-MRI检查评估心房纤维化程度,以此将患者分为轻度强化、中等强化和异常强化3组.术中切取左心耳标本通过病理组织学等检查评估心肌纤维化水平,比较DE-MRI检查与病理组织学检查的相关性.术后随访确定窦性心律维持率.结果 病理组织学等检查结果与术前DE-MRI检查所示的左心房延迟强化程度普遍具有相关性（r=0.69、0.48、0.65、0.51、0.47、0.52,P均＜0.05）,中度强化组1年窦率维持率显著高于异常强化组（85.7％比55.6％,P＜0.05）.结论 延迟增强MRI显像可用于对拟行房颤外科消融患者的预后评估.DE-MRI检查异常强化（＞35％）提示房颤消融手术的效果不佳.

Objective To investigate the value of Delayed Enhancement MRI（DE-MRI） in evaluating the prognosis of surgical ablation in patients with atrial fibrillation （AF） and the relationship between DE-MRI and histopathology examination.Methods From October 2013 to December 2015,43 AF patients undergoing surgical ablation got DE-MRI before the surgery and were divided into three groups according to the extent of atrial fibrosis.With the surgical occlusion process,the left atrial appendages were taken to histopathology examination and RTPCR.Results The results of DE-MRI were correlated with the histopathology examinations（r=0.69,0.48,0.65,0.51,0.47,0.52,P〈0.05）;the sinus rhythm rate in 1 year of the moderate-enhancement group was much higher than the unusual-enhancement group （80.0% vs 57.1%,P〈0.05）.Conclusion DE-MRI can be used to detect the extent of the atrial fibrosis and late enhancement area over 35% suggests poor prognosis.