心脏磁共振检查对不明原因急性心力衰竭患者的诊断价值

Diagnostic value of cardiac magnetic resonance for acute heart failure with unknown cause

目的评估心脏磁共振(MR)检查对不明原因急性心力衰竭(AHF)患者的诊断价值.方法采用回顾性研究方法,选择天津市第一中心医院2017年9月至2018年8月因不明原因AHF进行完整心脏MR检查(平扫+延迟增强)且图像质量满足诊断要求的11例患者,所有患者既往均无心脏相关病史,且实验室检查(血常规、血生化、心肌酶)、心电图(ECG)、超声心动图均缺乏明确诊断.此外,10例患者完成了侵入性冠状动脉(冠脉)造影或冠脉CT血管造影(CCTA)检查.记录患者实验室检查、ECG异常情况和超声心动图及心脏MR检查结果,分析超声心动图、心脏MR检查在不明原因AHF诊断和原因探寻中的应用价值.结果11例不明原因AHF患者中,9例MR检查发现了阳性结果,其中陈旧性心肌梗死3例,扩张性心肌病3例,淀粉样变性2例,心肌炎1例.心脏MR检测的左室收缩期末容积(LVESV)明显高于超声(mL:120.68±57.47比108.84±50.49,P<0.05),左室射血分数(LVEF)明显低于超声(0.36±0.09比0.43±0.10,P<0.05),瓣膜反流区也明显少于超声(11个比22个,P<0.05);而超声和心脏MR在左室舒张期末容积〔LVEDV(mL):183.37±65.26比182.26±70.44〕和心包积液患者数(6例比6例)方面比较差异均无统计学意义(均P>0.05).结论心脏MR通过对心肌组织学特点及心脏形态学、功能学改变及伴随征象(心包积液)的综合评价,最终为AHF患者治疗方案的选择、预后改善提供有价值的信息.

Objective To evaluate the diagnostic value of cardiac magnetic resonance(MR)for acute heart failure(AHF)with unknown cause.Methods A retrospective study was conducted,eleven patients with AHF with unknown cause admitted to Tianjin First Center Hospital from September 2017 to August 2018 were enrolled,and all the patients underwent complete cardiac MR imaging(plain MR and delayed enhancement imaging)with satisfactory image quality fulfilled the diagnostic requirement.Additionally,all of them had no history of heart disease and lack of diagnostic laboratory tests(routine blood test,blood biochemistry and myocardial enzyme),electrocardiogram(ECG)rhanges and echocardiography abnormality.Besides,10 patients had completed invasive coronary angiography or coronary CT angiography(CCTA);the results of laboratory tests,ECG abnormality,echocardiography and cardiac MR were recorded,and the values of echocardiography and cardiac MR examination in the diagnosis and exploring the cause of patients with AHF with unknown cause were analyzed.Results Nine of 11 patients with AHF with unknown cause had positive finding on cardiac MR examination;there were 3 patients with chronic myocardial infarction,3 with dilated cardiomyopathy,2 with cardiac involvement of amyloidosis and I with myocarditis.The left ventricular end systolic volume(LVESV)measured on cardial MR was significantly higher than that on echocardiography(mL:120.68±57.47 vs.108.84±50.49,P<0.05),the left ventricular ejection fraction(LVEF)and myocardial valvular regurgitation measured on MR were less than those on echocardiography(LVEF:0.36±0.09 vs.0.43±0.10;regurgitation:11 vs.22,both P<0.05);while,the differences of the end diastolic volume(LVEDV)and the number of patients with pericardial effusions between MR and echocardiography had no statistical significant differences[LVEDV(mL):183.37±65.26 vs.182.26±70.44:pericardial effusion:6 cases vs.6 cases,all P>0.051.Conclusion Cardiac MR could synthetically evaluate the heart by its morphology,function as well as accompanied sign(pericardial effusion)and cardiac tissue characteristics;eventually,it may provide valuable information concerning the selection of proper clinical therapeutic strategies and improvement of AHF patients'prognose.