扩张型心肌病与左心室心肌致密化不全患者慢血流特征分析

Coronary slow flow characteristics and diagnostic value for dilated cardiomyopathy versus left ventricular noncompaction

目的分析慢血流特征在诊断扩张型心肌病(dilated cardiomyopathy,DCM)与左心室心肌致密化不全(left ventricular noncompaction,LVNC)中的价值。研究对象选择2021年1至12月在武汉亚洲心脏病医院行冠状动脉造影检查未发现管腔狭窄的胸痛患者,同期行心脏磁共振确诊DCM或LVNC 52例。干预措施冠状动脉造影条件下左前降支(left anterior descending,LAD)心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)帧数除以1.7得到矫正的TIMI血流帧数计数(corrected TIMI frame count,CTFC)。将结果分为快CTFC组(CTFC<23)和慢CTFC组(23≤CTFC<40)两组。观察指标与测量方法分别计算DCM组和LVNC组患者左心室射血分数(left ventricular ejection fraction,LVEF)、过度小梁化心肌的节段数和CTFC,并计算每组患者间隔支支数,连续性计量资料以x±s表示,计数资料以数字或百分比表示,统计学分析采用两独立样本t检验或卡方检验或秩和检验,P<0.05为差异有统计学意义。结果确诊DCM患者35例,年龄(53.9±10.8)岁,男性31例(88.6%),LVEF为24.1%±8.7%,心肌过度小梁化26例(74.3%),其中5例受累节段大于4个;平均间隔支支数为3.5支,LAD慢血流28例(80%)。LVNC17例,年龄(58.4±10.1)岁,男性9例(52.9%),LVEF为32.3%±16.1%,心肌过度小梁化17例(100%),其中8例受累节段大于4个,平均间隔支支数为6.5支,LAD慢血流2例。2组LVEF差异有统计学意义(t=2.386,P=0.021),LVNC组LVEF明显高于DCM组;2组间慢血流差异有统计学意义(t=8.423,P<0.0001),DCM组LAD血流明显慢于LVNC组;2组间隔支支数差异有统计学意义(P<0.05),LVNC组间隔支支数为DCM组间隔支支数的1.9倍。结论DCM患者LAD具有慢血流特点,其间隔支支数也明显少于LVNC患者。

Objective To investigate the value of coronary slow flow(CSF)in differentiating dilated cardiomyopathy(DCM)from left ventricular noncompaction(LVNC).Subjects This study enrolled 52 patients with chest pain but without coronary artery lesions who underwent coronary angiography(CAG)and were diagnosed with DCM or LVNC within 1 week on cardiac magnetic resonance at the Wuhan Asia Heart Hospital between January and December 2021.Interventions The corrected Thrombolysis in Myocardial Infarction(TIMI)frame count(CTFC)of the left anterior descending artery(LAD)was obtained by dividing the TIMI frames by 1.7 on coronary angiography.Patients were divided into the fast CTFC group(CTFC<23)and the slow CTFC group(23≤CTFC<40),and the number of septal branches(SB)of the LAD was calculated.Main Outcomes and Measurements The left ventricular ejection fraction(LVEF),excessive trabecular myocardium,and CTFC of the DCM group and the LVNC group was calculated respectively,and the mean number of SB of each group was calculated.The measurement data were expressed as Mean±SD,while the counting data were expressed as number or percentage.The statistical analysis was performed of two independent samples.Values of P<0.05 are considered statistically significant.Results The DCM group(n=35)had a mean age of(53.9±10.8)years;88.6%were male.The mean LVEF was 24.1%±8.7%,and there were 26 cases of excessive trabecular myocardium(74.3%),of which five involved with more than four segments.The average number of SB was 3.5;there were 28 cases of coronary slow flow(CSF).Among the 17 patients with LVNC,the mean age was(58.4±10.1)years,52.9%were male,and the mean LVEF was 32.3%±16.1%.All 17 cases of excessive trabecular myocardium involved four or more segments;their average SB was 6.5,and there were two cases of CSF.There was a significant intergroup difference in mean LVEF(t=2.386;P=0.021),which was significantly higher in the LVNC versus DCM group.The CSF was significantly slower in the DCM versus LVNC group(t=8.423;P<0.0001).The number of SB was 1.9 times higher in the LVNC than DCM group.Conclusion The blood flow of LAD in patients with DCM was characterized by CSF,and significantly fewer SB were involved in patients with DCM versus LVNC.