围产期心肌病急性期心肌磁共振的特点及钆延迟强化对预后的影响

Characteristics of myocardial magnetic resonance imaging and influence of late gadolinium enhancement on prognosis in patients with peripartum cardiomyopathy

目的研究围产期心肌病(PPCM)急性期心肌磁共振成像(MRI)的特征及心肌MRI出现钆延迟强化(LGE)对患者预后的影响。方法回顾性分析2014年1月至2021年6月于郑州大学第一附属医院住院,且在急性期行心肌MRI的22例围产期心肌病患者的临床资料及心肌MRI特征。根据心肌MRI中有无LGE分为LGE阳性组(n=17),LGE阴性组(n=5),比较两组患者的临床特点、心肌MRI特征、治疗情况及住院期间的心血管不良事件。结果22例围产期心肌病患者的心肌MRI中,LGE的发生率为77.3%。两组基线临床资料无统计学差异。在LGE阳性组心肌MRI的射血分数(EF)值更低[20.74(17.57,33.55)%vs.34.58(27.72,47.41)%,P=0.026]。LGE阳性组的主要不良心血管事件发生2例(11.8%,其中1例放弃治疗后院外死亡,1例院内出现心室颤动给予电除颤,而后植入ICD),在LGE阴性组,无心血管不良事件发生。LGE阳性组除1例死亡外,其他16例完成心脏超声随访,LGE阴性组5例完成心脏超声随访,EF值分别为[(53.88±11.19)%vs.(61.00±2.35)%,P=0.028]。两组间分别有10例(62.5%),4例(80.0%)心功能恢复至正常。在LGE阴性组,随访后EF值明显更高,心功能恢复正常的比例高于LGE阳性组,但两组恢复正常的比例并无统计学差异。结论围产期心肌病急性期的心肌MRI中LGE较为常见,LGE的存在预示着远期更低的射血分数。

Objective To study the characteristics of myocardial magnetic resonance imaging(MRI)and influence of late gadolinium enhancement(LGE)on prognosis in patients with acute phase peripartum cardiomyopathy(PPCM).Methods The clinical materials and MRI characteristics of patients(n=22)with acute phase PPCM undergone myocardial MRI were retrospectively analyzed in the First Affiliated Hospital of Zhengzhou University from Jan.2014 to June 2021.All patients were divided,according to whether there was LGE in myocardial MRI or not,into positive LGE group(n=17)and negative LGE group(n=5).The clinical characteristics,myocardial MRI features,treatment and major adverse cardiovascular events(MACE)occurred during hospitalization.Results Among myocardial MRI of 22 patients with acute phase PPCM,the incidence rate of LGE was 77.3%.The baseline clinical materials had no statistical difference between 2 groups.The value of ejection fraction(EF)of myocardial MRI was lower in positive LGE group[20.74(17.57,33.55)%vs.34.58(27.72,47.41)%,P=0.026].There were 2 cases of major adverse cardiovascular events(MACE)in positive LGE group and there was no MACE case in negative LGE group.Except of 1 case died,there were 16 patients in positive LGE group and 5 patients in negative LGE group received follow-up of echocardiography,and EF value was(53.88±11.19)%vs.(61.00±2.35)%(P=0.028).The heart function recovered in 10 cases(62.5%)in positive LGE group and in 4 cases(80.0%)in negative LGE group.The value of EF was significantly higher in negative LGE group.The percentage of patients with recovered heart function were higher in negative LGE group than those in positive LGE group after follow-up,but had no statistical difference between 2 groups.Conclusion LGE is common in myocardial MRI in patients with acute phase PPCM,and LGE indicates lower EF in the future.