肥厚型心肌病类缺血样强化方式的发生率、MRI影像特征及临床价值

Incidence of ischemic-like enhancement in hypertrophic cardiomyopathy,characteristics of MRI and its clinical value

目的探究肥厚型心肌病类缺血样强化方式的发生率、MRI影像特征及其临床价值。方法回顾性选取2018年1月至2019年1月来自山东第一医科大学附属济南医院接受MRI筛查且经医师诊断为肥厚型心肌病的患者2136例,其中延迟强化的患者829例,而其中符合类缺血样强化的患者58例。将58例类缺血样强化患者作为观察组,另选延迟强化患者58例作为对照组,对两组患者进行MRI影像诊断,观察其左心室射血分数(LVEF)、心肌延迟强化(LEG)体积、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、心脏指数(CI)以及不良心血管事件发生率。结果类缺血样强化方式的发生率约为7%(58/829)。观察组患者的LVEF、LGE、LVESV、CI分别为(69.9±3.1)%、(22. 1±6. 3)%、(55. 3±21. 4) ml和(2. 8±0. 9) ml/m^2,明显高于对照组的(60. 2±3. 3)%、(2. 7±1. 5)%、(46. 1±18. 7) ml和(1. 9±0. 6) ml/m^2。而观察组LVEDV为(121. 1±38. 6) ml,较对照组的(136. 4±45. 3) ml偏低,差异具有统计学意义(P <0. 05)。观察组患者的心率不齐、心律失常以及猝死等不良心血管事件的发生率(5. 2%)明显低于对照组(25. 9%),差异具有统计学意义(P <0. 05)。按照AHA划分心脏强化节段,观察组中类缺血样强化最多分布于16节、15节、14节、9节、8节和3节中,主要位于心尖部和左心室内。结论类缺血样强化是肥厚型心肌病延迟强化中的一种特殊强化类型,不良心血管事件发生率较低,通过MRI影像检查可以发现,类缺血样强化的对于肥厚型心肌病的诊疗具有可预见性,与患者的LVEFF等指标具有较强的相关性。

Objective To investigate the incidence of ischemic-like enhancement in hypertrophic cardiomyopathy,the imaging characteristics of MRI and its clinical value. Methods From January 2018 to January 2019,2136 patients diagnosed as hypertrophic cardiomyopathy in Jinan People’s Hospital Affiliated to Shandong First Medical University were selected retrospectively for MRI screening,829 of them were delayed enhancement patients,58 of them were matched with hypokalemic enhancement patients. 58 patients with ischemic like enhancement were selected as the observation group and 58 patients with delayed enhancement as the control group. The MRI images of the two groups were diagnosed,and the Left ventricular ejection fraction( LVEF),late gadolinium enhancement( LEG),eft ventricular end systolic volume( LVESV),left ventricular end diastolic volume( LVEDV),cardiac index( CI) and the incidence of adverse cardiovascular events were observed. Results The incidence of enhancement of hypokalemia was about 7%( 58/829). LVEF,LGE,LVESV,CI were( 69. 9 ± 3. 1) %,( 22. 1 ± 6. 3) %,( 55. 3 ±21. 4) ml and( 2. 8 ± 0. 9) ml/m^2 in the observation group,respectively. significantly higher than the control group( 60. 2 ± 3. 3) %,( 2. 7 ±1. 5) %,( 46. 1 ± 18. 7) ml and( 1. 9 ± 0. 6) ml/m^2. The LVEDV of the observation group was( 121. 1 ± 38. 6) ml,which was lower than that of the control group( 136. 4 ± 45. 3) ml,the difference was statistically significant( P < 0. 05). The incidence of adverse cardiovascular events in the observation group was 5. 2%,much lower than that in the control group( 25. 9%)( P < 0. 05). According to the AHA classification of cardiac enhancement segments,in the observation group,the majority of hypospadias were distributed in 16,15,14,9,8 and 3 segments,mainly in the apex and left ventricle. Conclusion Ischemic enhancement is a special type of delayed enhancement in hypertrophic cardiomyopathy. The incidence of adverse cardiovascular events is relatively low. Through MRI imaging,it can be found that the diagnosis and treatment of hypertrophic cardiomyopathy is predictable,and has a strong correlation with LVEFF and other indicators of patients.