心脏磁共振对肥厚型心肌病患者心功能评估及心血管不良事件的预测价值

Evaluating cardiac function by using cardiac magnetic resonance imaging for patients with hypertrophic cardiomyopathy and its value in predicting adverse cardiovascular events

目的探析心脏磁共振(CMRI)对肥厚型心肌病(AHCM)患者的心功能评估以及对心血管不良事件的预测价值。方法选择2016年7月—2019年7月本院收治的60例AHCM患者作为研究对象,按照患者是否发生心血管不良事件分为观察组和对照组两组,将已发生心血管不良事件的25例AHCM患者设为观察组,另35例未发生心血管不良事件的AHCM患者设为对照组。两组患者均行心脏磁共振(CMRI)检查.记录两组患者的CMRI表现和两组患者的左室收缩末期内径(LVDs)、左室舒张末期容积(LVEDV)、左心室舒张末内径(LVDD)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)等心功能指标。分析CMRI相关心功能参数的检测对AHCM患者心血管不良事件的预测价值。结果经CMRI检查,观察组16例为梗阻型AHCM,9例为非梗阻型AHCM;对照组12例为梗阻型AHCM,23例为非梗阻型AHCM;观察组AHCM患者的心肌质量、室间隔厚度、前壁厚度、后壁厚度及心尖厚度均大于对照组,差异有统计学意义(P<0.05);两组患者LVDs、RVEDV及RVESV比较,差异无统计学意义(P>0.05);观察组患者的LVDd、LVESV、LVEDV、LVEF等心功能指标均显著高于对照组,差异有统计学意义(P<0.05);LVDd、LVESV、LVEDV、LVEF等CMRI参数是预测AHCM患者发生心血管不良事件的敏感指标,其95%CI分别是(1.031~1.321)、(1.015~1.357)、(1.110~11.128)和(3.156~476.658),差异无统计学意义(P>0.05)。结论CMRI检查可反映AHCM患者的心功能状况,对心血管不良事件的发生有潜在的预测价值。

Objective To explore the value of cardiac magnetic resonance imaging(CMRI)in evaluating cardiac function for patients with apical hypertrophic cardiomyopathy(AHCM)and predicting adverse cardiovascular events.Methods Sixty patients with AHCM who were admitted and treated in the hospital between July 2016 and July 2019 were divided into observation group(25 cases with adverse cardiovascular events)and control group(35 cases without adverse cardiovascular events).All subjects underwent CMRI examination.The cardiac function indexes[left ventricular end-systolic diameter(LVDs),left ventricular end-diastolic volume(LVEDV),left ventricular diastolic diameter(LVDD),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),right ventricle end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV)]in both groups were detected.The predictive value of CMRI-related cardiac function parameters for adverse cardiovascular events in AHCM patients was analyzed.Results CMRI examination found 16 cases with obstructive AHCM and 9 cases with non-obstructive AHCM in the observation group,12 cases with obstructive AHCM and 23 cases with non-obstructive AHCM in the control group.Myocardial mass,interventricular septal thickness,anterior wall thickness,posterior wall thickness and apex thickness of the observation group were significantly larger than those of the control group(P<0.05).The cardiac function indexes(LVDd,LVESV,LVEDV,LVEF)in observation group were significantly higher than those in control group(P<0.05).The CMRI parameters such as LVDd,LVESV,LVEDV and LVEF were sensitive indexes for predicting adverse cardiovascular events in AHCM patients.And their 95%CI values were(1.031-1.321),(1.015-1.357),(1.110-11.128)and(3.156-476.658),respectively(P<0.05).Conclusions CMRI examination could reflect the cardiac function status of AHCM patients,which is of potential predictive value for the occurrence of adverse cardiovascular events.