心脏磁共振评价心尖肥厚型心肌病患者左心房室结构、功能及其相关性研究

Evaluation of the left atrioventricular structure, function and correlation in patients with apical hypertrophic cardiomyopathy by cardiac magnetic resonance imaging

目的用心脏磁共振评估心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)患者心脏形态及左心室舒张功能变化,并评估左心室舒张功能与心尖部厚度及左房形态、功能之间的关系。材料与方法回顾性分析2015年9月至2018年7月于我院就诊并完成心脏磁共振、心电图及超声心动检查的患者,挑选出其中AHCM患者69例及健康对照组25例,比较两组之间左心室射血分数(left ventrical ejection fraction,LVEF)、左心室心肌质量、左心室心肌厚度、收缩末期左房容积(left atrial end systolicvolume,LAESV)、左房整体峰值纵向应变(left atrial peak global longitudinal strain,LAPGLS)、左房整体峰值周向应变(left atrial peak global circumferential strain,LAPGCS)及左房面积变化分数(fraction area change,FAC)的差异,以及LAPGLS和LAPGCS与其他左心房室结构及功能参数之间的相关性。结果心尖肥厚型心肌病组左心室心尖部厚度、左心室心肌质量、LVEF、LAESV均明显高于正常对照组,LAPGLS及FAC均明显低于正常对照组,两组之间的差异均有统计学意义(P<0.05),而两组之间的LAPGCS差异则没有统计学意义。结论心尖肥厚型心肌病患者左心室舒张功能下降,而左心房收缩功能未发生明显变化。左心房FAC可作为LAPGLS的替代指标来判断左心室舒张功能是否下降。

Objective: To evaluate the changes of cardiac morphology and left ventricular diastolic function in patients with apical hypertrophic cardiomyopathy (AHCM) by cardiac magnetic resonance imaging (CMRI).Materials and Methods: We retrospectively analyzed the patients in our hospital who underwent CMRI,electrocardiogram (ECG) and echocardiography during the time between September 2015 to July 2018.Sixty nine cases AHCM and 25 health controls were picked out.The left ventricular ejection fraction (LVEF),left ventricular myocardial mass,thickness of left apical ventricular wall,left atrial end systolic volume index (LAESV),left atrial peak global longitudinal strain (LAPGLS),left atrial peak global circumferential strain (LAPGCS),and left atrium fraction area change (FAC) were compared between the two groups.And the correlation between LAPGLS,LAPGCS and other left atrium and ventricular structural and functional parameters were analyzed.Results: In AHCM group, the thickness of apical ventricular wall,myocardial mass,LVEF and LAESV were significantly higher than those of normal control group,while LAPGLS and FAC were lower than those of the normal control group.The differences between the two groups were statistically significant, while LAPGCS between the two groups had no difference.Conclusions: In patients with apical hypertrophic cardiomyopathy,left ventricular diastolic function (LAPGLS) decreased,while left atrial systolic function (LAPGCS) did not change significantly.FAC of the left atrium can be used as an alternative indicator of LAPGLS to determine whether the diastolic function of the left ventricle is declined.