肥厚型心肌病患者临床特征与基于心脏磁共振评估的心肌纤维化范围间的关系

Relationships between Clinical Characteristics and the Extent of Myocardial Fibrosis Assessed by Cardiac Magnetic Resonance in Patients with Hypertrophic Cardiomyopathy

目的探讨肥厚型心肌病患者临床特征与基于心脏磁共振(cardiac magnetic resonance,CMR)评估的心肌纤维化范围间的关系。方法本研究纳入2017年1月至2021年6月邯郸市第一医院收治的肥厚型心肌病患者共96例,根据是否晚期钆增强(late gadolinium enhancement,LGE)状态和心肌肥厚程度分组,分析各组患者的一般资料、超声心动图及CMR检查资料,采用Pearson检验或Spearman检验评价肥厚型心肌病患者临床特征资料与LGE%间的相关性。结果(1)96例患者中LGE阳性68例,阳性节段共126个,LGE%为32.56%±12.10%;阳性组患者的年龄、左心室射血分数(left ventricular ejection fraction,LVEF)及心脏指数分别为(43.24±5.37)岁、63.98%±15.20%、(2.99±0.61)L·min~(-1)·m~(-2),均显著低于阴性组患者的(51.79±7.18)岁、69.31%±8.46%、(3.07±0.64)L·min~(-1)·m~(-2),差异有统计学意义(P<0.05);阳性组患者的纽约心脏学会(New York Heart Association,NYHA)心功能分级Ⅲ~Ⅳ级比例、左心室舒张末期最大室壁厚度(left ventricular maximum wall thickness,LVMWT)、左心室质量指数、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、心肌肌钙蛋白(cardiac troponin,cTn)I、肌红蛋白(myoglobin,MYO)及肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)分别为29.41%(20/68)、(2.35±0.41)cm、(128.64±16.77)g/m^(2)、(157.14±30.37)mL/m^(2)、(2815.14±610.02)ng/L、(0.90±0.24)μg/L、(66.28±17.38)μg/L、(3.30±0.48)μg/L,均显著高于阴性组的0.00%(0/28)、(1.80±0.24)cm、(79.49±13.81)g/m^(2)、(148.89±25.18)ml/m^(2)、(870.13±207.55)ng/L、(0.17±0.04)μg/L、(28.35±4.42)μg/L、(0.81±0.14)μg/L,差异均有统计学意义(P<0.05)。(2)LGE阳性68例患者中轻度、中度及重度肥厚分别为30例、20例、18例;重度肥厚亚组LGE%、NT-proBNP及cTnI分别为34.84%±8.30%、(3371.93±640.81)ng/L、(2.69±0.51)μg/L,均显著高于轻度肥厚亚组的6.96%±1.47%、(2124.74±497.66)ng/L、(0.88±0.15)μg/L,中度肥厚亚组的22.42%±6.79%、(1124.38±302.42)ng/L、(0.10±0.01)μg/L(P<0.05);同时中度肥厚亚组LGE%、NT-proBNP及cTnI均显著高于轻度肥厚亚组,差异均有统计学意义(P<0.05)。(3)相关性分析结果显示,肥厚型心肌病患者LGE%与年龄呈负相关性(P<0.05);同时肥厚型心肌病患者LGE%与NT-proBNP、cTnI、LVDSV、LVMWT及左心室质量指数均呈正相关(P<0.05)。结论行CMR检查肥厚型心肌病患者心肌纤维化范围与多种临床特征资料密切相关;随年龄增加,心肌纤维化范围缩小,而NT-proBNP、cTnI、LVDSV、LVMWT及左心室质量指数与心肌纤维化范围的关系则相反。

Objectives To investigate the relationships between clinical characteristics and the extent of myocardial fibrosis assessed by cardiac magnetic resonance(CMR)in patients with hypertrophic cardiomyopathy.Methods Totally 96 patients with hypertrophic cardiomyopathy examined by CMR were retrospectively chosen in the period from January 2017 to June 2021 in Handan First Hospital.All the patients were grouped according to the presence of late gadolinium enhancement(LGE)and the myocardial hypertrophy degree.The general data,echocardiography and CMR were analyzed and Pearson test or Spearman test were used to evaluate the correlations between clinical characteristics and LGE%in patients with hypertrophic cardiomyopathy.Results(1)Sixty-eight cases of all the 96 patients were positive for LGE with 126 positive segments and the average value of LGE%was 32.56%±12.10%.The age,left ventricular ejection fraction(LVEF)and cardiac index in positive group for(43.24±5.37)years old,63.98%±15.20%,(2.99±0.61)L·min-1·m-2 were significantly lower than negative group for(51.79±7.18)years old,69.31%±8.46%,(3.07±0.64)L·min-1·m-2(P<0.05).The proportion of New York Heart Association(NYHA)heart function gradeⅢ-Ⅳ,left ventricular maximum wall thickness(LVMWT),left ventricular mass index,left ventricular end-diastolic volume(LVEDV),N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin(cTn)I,myoglobin(MYO)and creatine kinase isoenzymes(CK-MB)in positive group for 29.41%(20/68),(2.35±0.41)cm,(128.64±16.77)g/m^(2),(157.14±30.37)mL/m^(2),(2815.14±610.02)ng/L,(0.90±0.24)μg/L,(66.28±17.38)μg/L,(3.30±0.48)μg/L were significantly higher than negative group for 0.00%(0/28),(1.80±0.24)cm,(79.49±13.81)g/m^(2),(148.89±25.18)mL/m^(2),(870.13±207.55)ng/L,(0.17±0.04)μg/L,(28.35±4.42)μg/L,(0.81±0.14)μg/L(P<0.05).(2)Thirty cases were mild hypertrophy,20 cases were moderate hypertrophy and 18 cases were severe hypertrophy,respectively in all 68 patients with LGE positive.The levels of LGE,NT proBNP and cTnI in severe hypertrophic subgroup for 34.84%±8.30%,(3371.93±640.81)ng/L,(2.69±0.51)μg/L were significantly higher than those in mild hypertrophic subgroup for 6.96%±1.47%,(2124.74±497.66)ng/L,(0.88±0.15)μg/L and moderate hypertrophic subgroup for 22.42%±6.79%,(1124.38±302.42)ng/L,(0.10±0.01)μg/L(P<0.05).The levels of LGE,NT proBNP and cTnI in moderate hypertrophic subgroup were significantly higher than those in mild hypertrophic subgroup(P<0.05).(3)The results of correlation analysis showed that LGE%in patients with hypertrophic cardiomyopathy negatively correlated with age.LGE%in patients with hypertrophic cardiomyopathy positively correlated with NT-proBNP,cTnI,LVDSV,LVMW and left ventricular mass index(P<0.05).Conclusions The extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy by CMR is closely related to a variety of clinical characteristics.With the increase of age,the scope of myocardial fibrosis decreases,while the relationships between NT-proBNP,cTnI,LVDSV,LVMWT and left ventricular mass index with the scope of myocardial fibrosis were opposite.