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Association between late gadolinium enhancement and outcome in dilated cardiomyopathy:A meta-analysis
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作者 Xin-Yi Feng Wen-Feng He +5 位作者 Tian-Yue Zhang Ling-Li Wang Fan Yang Yu-Ling Feng Chun-Ping Li Rui Li 《World Journal of Radiology》 2023年第11期324-337,共14页
BACKGROUND The prognostic value of late gadolinium enhancement(LGE)derived from cardiovascular magnetic resonance(CMR)is well studied,and several new metrics of LGE have emerged.However,some controversies remain;there... BACKGROUND The prognostic value of late gadolinium enhancement(LGE)derived from cardiovascular magnetic resonance(CMR)is well studied,and several new metrics of LGE have emerged.However,some controversies remain;therefore,further discussion is needed,and more precise risk stratification should be explored.AIM To investigate the associations between the positivity,extent,location,and pattern of LGE and multiple outcomes in dilated cardiomyopathy(DCM).METHODS PubMed,Ovid MEDLINE,and Cochrane Library were searched for studies that investigated the prognostic value of LGE in patients with DCM.Pooled hazard ratios(HRs)and 95%confidence intervals were calculated to assess the role of LGE in the risk stratification of DCM.RESULTS Nineteen studies involving 7330 patients with DCM were included in this metaanalysis and covered a wide spectrum of DCM,with a mean left ventricular ejection fraction between 21%and 50%.The meta-analysis revealed that the presence of LGE was associated with an increased risk of multiple adverse outcomes(all-cause mortality,HR:2.14;arrhythmic events,HR:5.12;and composite endpoints,HR:2.38;all P<0.001).Furthermore,every 1%increment in the extent of LGE was associated with an increased risk of all-cause mortality.Analysis of a subgroup revealed that the prognostic value varied based on different location and pattern of LGE.Additionally,we found that LGE was a stronger predictor of arrhythmic events in patients with greater left ventricular ejection fraction.CONCLUSION LGE by CMR in patients with DCM exhibited a substantial value in predicting adverse outcomes,and the extent,location,and pattern of LGE could provide additional information for risk stratification. 展开更多
关键词 cardiac magnetic resonance Dilated cardiomyopathy late gadolinium enhancement META-ANALYSIS myocardial fibrosis PROGNOSIS
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Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices 被引量:2
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作者 El-Sayed H Ibrahim Mason Runge +6 位作者 Jadranka Stojanovska Prachi Agarwal Maryam Ghadimi-Mahani Anil Attili Thomas Chenevert Chiel den Harder Frank Bogun 《World Journal of Radiology》 CAS 2018年第9期100-107,共8页
Late gadolinium enhancement(LGE) cardiovascular magnetic resonance(CMR) is the gold standard for imaging myocardial viability.An important application of LGE CMR is the assessment of the location and extent of the myo... Late gadolinium enhancement(LGE) cardiovascular magnetic resonance(CMR) is the gold standard for imaging myocardial viability.An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia(VT), which allows for more accurate identification of the ablation targets.However, a large percentage of patients with VT have cardiac implantable electronic devices(CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns.Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted.Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts.These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation.In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware.The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images. 展开更多
关键词 magnetic resonance IMAGING Heart late gadolinium enhancement VIABILITY IMAGING Inversion recovery cardiac IMPLANTABLE electronic devices
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Fully Automatic Scar Segmentation for Late Gadolinium Enhancement MRI Images in Left Ventricle with Myocardial Infarction
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作者 Zheng-hong WU Li-ping SUN +8 位作者 Yun-long LIU Dian-dian DONG Lv TONG Dong-dong DENG Yi HE Hui WANG Yi-bo SUN Jian-zeng DONG Ling XIA 《Current Medical Science》 SCIE CAS 2021年第2期398-404,共7页
Numerous methods have been published to segment the infarct tissue in theleft ventricle, most of them either need manual work, post-processing, or suffer from poorreproducibility. We proposed an automatic segmentation... Numerous methods have been published to segment the infarct tissue in theleft ventricle, most of them either need manual work, post-processing, or suffer from poorreproducibility. We proposed an automatic segmentation method for segmenting the infarct tissue irleft ventricle with myocardial infarction. Cardiac images of a total of 60 diseased hearts (55 humanhearts and 5 porcine hearts) were used in this study. The epicardial and endocardial boundariesof the ventricles in every 2D slice of the cardiac magnetic resonance with late gadoliniumenhancement images were manually segmented. The subsequent pipeline of infarct tissuesegmentation is fully automatic. The segmentation results with the automatic algorithm proposed inthis paper were compared to the consensus ground truth. The median of Dice overlap between ourautomatic method and the consensus ground truth is 0.79. We also compared the automatic methodwith the consensus ground truth using different image sources from diferent centers with diferentscan parameters and different scan machines. The results showed that the Dice overlap with thepublic dataset was 0.83, and the overall Dice overlap was 0.79. The results show that our method isrobust with respect to different MRI image sources, which were scanned by different centers withdifferent image collection parameters. The segmentation accuracy we obtained is comparable toor better than that of the conventional semi-automatic methods. Our segmentation method may beuseful for processing large amount of dataset in clinic. 展开更多
关键词 myocardial infarction cardiac magnetic resonance with late gadolinium enhancement automatic scar segmentation
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Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings
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作者 George Bazoukis Sebastian Garcia-Zamora +8 位作者 GökselÇinier Sharen Lee Enes Elvin Gul JesúsÁlvarez-García Gabi Miana Mertİlker Hayıroğlu Gary Tse Tong Liu Adrian Baranchuk 《World Journal of Cardiology》 2022年第9期483-495,共13页
BACKGROUND Cardiac magnetic resonance(CMR)is a unique tool for non-invasive tissue characterization,especially for identifying fibrosis.AIM To present the existing data regarding the association of electrocardiographi... BACKGROUND Cardiac magnetic resonance(CMR)is a unique tool for non-invasive tissue characterization,especially for identifying fibrosis.AIM To present the existing data regarding the association of electrocardiographic(ECG)markers with myocardial fibrosis identified by CMR-late gadolinium enhancement(LGE).METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).RESULTS A total of 32 studies were included.In hypertrophic cardiomyopathy(HCM),fragmented QRS(fQRS)is related to the presence and extent of myocardial fibrosis.fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients,while fQRS has also been related to fibrosis in myocarditis.Selvester score,abnormal Q waves,and notched QRS have also been associated with LGE.Repolarization abnormalities as reflected by increased Tp-Te,negative Twaves,and higher QT dispersion are related to myocardial fibrosis in HCM patients.In patients with Duchenne muscular dystrophy,a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed.In atrial fibrillation patients,advanced inter-atrial block is defined as P-wave duration≥120 ms,and biphasic morphology in inferior leads is related to left atrial fibrosis.CONCLUSION Myocardial fibrosis,a reliable marker of prognosis in a broad spectrum of cardiovascular diseases,can be easily understood with an easily applicable ECG.However,more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR. 展开更多
关键词 myocardial fibrosis late gadolinium enhancement ELECTROCARDIOGRAM cardiac magnetic resonance
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Distribution of late gadolinium enhancement in various types of cardiomyopathies:Significance in differential diagnosis, clinical features and prognosis 被引量:9
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作者 Hiroshi Satoh Makoto Sano +6 位作者 Kenichiro Suwa Takeji Saitoh Mamoru Nobuhara Masao Saotome Tsuyoshi Urushida Hideki Katoh Hideharu Hayashi 《World Journal of Cardiology》 CAS 2014年第7期585-601,共17页
The recent development of cardiac magnetic resonance(CMR)techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution.We review characteristic CMR features in i... The recent development of cardiac magnetic resonance(CMR)techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution.We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies(ICM and NICM),especially in terms of the location and distribution of late gadolinium enhancement(LGE).CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory,and the subendocardial or transmural LGE.LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer.The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function,including dilated cardiomyopathy,end-stage hypertrophic cardiomyopathy(HCM),cardiac sarcoidosis,and myocarditis,and those with diffuse left ventricular(LV)hypertrophy including HCM,cardiac amyloidosis and Anderson-Fabry disease.A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy.In arrhythmogenic right ventricular cardiomyopathy/dysplasia,an enhancement of right ventricular(RV)wall with functional and morphological changes of RV becomes apparent.Finally,the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments. 展开更多
关键词 CARDIOMYOPATHY cardiac magnetic resonance late gadolinium enhancement cardiac function Clinical features PROGNOSIS
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Prognostic Value of Feature-Tracking Circumferential Strain in Dilated Cardiomyopathy Patients with Severely Reduced Ejection Fraction Incremental to Late Gadolinium Enhancement 被引量:7
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作者 Shcng-lei SHU Jing WANG +6 位作者 Cheng WANG Feng ZHU Yu-xi JIA Lan ZHANG Xiao-yue ZHOU Tian-jing ZHANG Chuan-sheng ZHENG 《Current Medical Science》 SCIE CAS 2021年第1期158-166,共9页
Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prog... Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prognostic value of global circumferential strain(GCS)in dilated cardiomyopathy(DCM)patients with severely impaired systolic function.This study aimed to evaluate the prognostic value of cardiac magnetic resonance(CMR)-derived GCS in DCM patients with severely reduced ejection.Consecutive DCM patients with severely reduced ejection fraction(EF<35%)who underwent CMR were included.GCS was calculated from CMR cine images.The clinical endpoint was a composite of all-cause mortality,heart transplantation,implantable cardioverter defibrillator(ICD)implantation and aborted sudden cardiac death(SCD).A total of 129 patients with a mean EF of 15.33%(11.36%–22.27%)were included.During a median follow-up of 518 days,endpoint events occurred in 50 patients.Patients with GCS≥the median(−5.17%)had significantly reduced event-free survival as compared with those with GCS<the median(P<0.01).GCS was independently associated with adverse events after adjusting for clinical and imaging risk factors including extent of late gadolinium enhancement(LGE)(P<0.05).Adding GCS into the model including the extent of LGE resulted in significant improvements in the C-statistic(from 0.706 to 0.742;P<0.05)with a continuous net reclassification improvement(NRI)of 29.71%.It was concluded that GCS derived from CMR could be useful for risk stratification in DCM patients with severely reduced EF,which may increase common imaging risk factors including LGE. 展开更多
关键词 cardiac magnetic resonance imaging circumferential strain PROGNOSIS late gadolinium enhancement dilated cardiomyopathy
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Cardiac magnetic resonance in clinical cardiology 被引量:3
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作者 Andreas Kumar Rodrigo Bagur 《World Journal of Cardiology》 CAS 2015年第1期6-9,共4页
Over the last decades, cardiac magnetic resonance(CMR) has transformed from a research tool to a widely used diagnostic method in clinical cardiology. This method can now make useful, unique contributions to the work-... Over the last decades, cardiac magnetic resonance(CMR) has transformed from a research tool to a widely used diagnostic method in clinical cardiology. This method can now make useful, unique contributions to the work-up of patients with ischemic and non-ischemic heart disease. Advantages of CMR, compared to other imaging methods, include very high resolution imaging with a spatial resolution up to 0.5 mm × 0.5 mm in plane, a large array of different imaging sequences to provide in vivo tissue characterization, and radiationfree imaging. The present manuscript highlights the relevance of CMR in the current clinical practice and new perspectives in cardiology. 展开更多
关键词 cardiac magnetic resonance gadolinium enhancement MYOCARDITIS myocardial CARDIOMYOPATHY
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The Detectability for the Myocardial Fibrosis by Tagging Imaging on Cardiovascular Magnetic Resonance 被引量:1
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作者 Atsushi K. Kono Pierre Croisille +6 位作者 Tatsuya Nishii Katsusuke Kyotani Koya Nishiyama Mayumi Shigeru Sachiko Takamine Sei Fujiwara Kazuro Sugimura 《Open Journal of Radiology》 2014年第1期1-8,共8页
Purpose: Myocardial fibrosis causes cardiac dysfunction, arrhythmias, and sudden death. Tagging imaging on cardiovascular MR can measure the intra-myocardial motion from the dynamic deformation of lines superimposed o... Purpose: Myocardial fibrosis causes cardiac dysfunction, arrhythmias, and sudden death. Tagging imaging on cardiovascular MR can measure the intra-myocardial motion from the dynamic deformation of lines superimposed on the myocardium. The purpose of this study was to evaluate the detectability of myocardial fibrosis using tagging imaging and to compare this with conventional cine imaging. Materials and Methods: We reviewed 4 normal control (NML) subjects, 4 patients with myocarditis (MYO), and 4 patients with old myocardial infarction (ICM). We measured circumferential strain (Ecc) from tagging imaging, and regional wall thickening (rWT) from cine imaging. Fibrosis was determined from a late gadolinium enhancement (LGE) image. We evaluate diagnostic performance by comparing values of the area under curve (AUC) using ROC analysis. Results: Mean values of Ecc and rWT decreased in the area of LGE both in MYO and ICM patients. AUC values of Ecc and rWT in all subjects were 0.98 and 0.84, respectively (p < 0.0001). These values in MYO patients were 0.95 and 0.72 (p = 0.007), respectively, and 0.99 and 0.75, respectively, in ICM patients (p = 0.0008). Conclusions: Both Ecc and rWT decreased in the area with fibrosis in the patients with MYO and ICM. Tagging imaging showed better detectability of myocardial fibrosis than did cine imaging. 展开更多
关键词 Tagging IMAGING late gadolinium enhancement myocardial FIBROSIS CARDIOVASCULAR magnetic resonance
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基于磁共振深度学习图像重建算法的心肌延迟强化在未识别心肌梗死中的应用
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作者 陆雪芳 闫玉辰 +3 位作者 龚威 权光南 刘薇音 查云飞 《磁共振成像》 CAS CSCD 北大核心 2024年第10期8-14,49,共8页
目的探讨基于磁共振深度学习重建(deep learning reconstruction,DLR)算法的心肌延迟强化(late gadolinium enhancement,LGE)提高临床未识别心肌梗死(unrecognized myocardial infarction,UMI)患者识别率的诊断价值。材料与方法前瞻性纳... 目的探讨基于磁共振深度学习重建(deep learning reconstruction,DLR)算法的心肌延迟强化(late gadolinium enhancement,LGE)提高临床未识别心肌梗死(unrecognized myocardial infarction,UMI)患者识别率的诊断价值。材料与方法前瞻性纳入2022年4月至2023年8月于我院就诊的可疑UMI并完成心脏磁共振(cardiac magnetic resonance,CMR)检查的患者98例,分析常规重建的原始LGE(original LGE,LGE_(O))及通过DLR算法获得的LGE(DLR LGE,LGE_(DL))短轴位图像。测量两组图像心肌的信噪比(signal-to-noise ratio,SNR)、对比噪声比(contrast-to-noise ratio,CNR)、标准差(standard deviation,SD)。采用2~5倍标准差(2SD~5SD)法以及全宽半高(full width at half maximum,FWHM)法进行强化面积百分比(percentage of enhanced area,P_(area))分析。评估心肌整体各测量值的组内及组间一致性。以临床诊断UMI为金标准计算LGE_(DL)和LGE_(O)的诊断效能。结果SNR_(DL)和CNR_(DL)均较SNR_(O)和CNR_(O)提高超过2倍(P<0.001)。LGE_(DL)序列心肌、强化灶及背景噪声SDDL较SD_(O)均显著减低(P均<0.001)。不同阈值法分析,P_(area-DL)较P_(area-O)序列升高,以2SD法为著(P<0.001),但FWHM法中差异无统计学意义(P>0.05)。整体心肌SNR、CNR、不同阈值法P_(area)测量值组内及组间一致性好[组内相关系数(intra-class correlation coefficient,ICC)>0.600,P均<0.001]。受试者工作特征(receiver operating characteristic,R_(O)C)曲线分析显示,每种SD方法在检测UMI方面都表现出良好的诊断效果,其中以5SD P_(area-DL)法最优(P<0.001)。结论DLR能显著提高LGE的图像质量。当LGE_(DL)和LGE_(O)的信号阈值与参考平均值(signal threshold versus reference mean,STRM)分别≥4SD和≥3SD时,对UMI的诊断效果较好。 展开更多
关键词 未识别心肌梗死 诊断效能 深度学习重建 钆延迟强化 磁共振成像
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心脏磁共振参数列线图模型对扩张型心肌病老年患者不良心血管事件的预测价值
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作者 王玲 鲁国卫 +3 位作者 章宏 尹成俊 陈凤 田荣华 《分子影像学杂志》 2024年第1期71-77,共7页
目的 探究心脏磁共振(CMR)参数列线图模型对扩张型心肌病(DCM)老年患者主要不良心血管事件(MACE)的预测价值。方法 回顾性分析2017年7月~2020年7月在武汉科技大学附属孝感医院接受CMR检查的DCM老年患者173例,将患者按6:4的比例随机分为... 目的 探究心脏磁共振(CMR)参数列线图模型对扩张型心肌病(DCM)老年患者主要不良心血管事件(MACE)的预测价值。方法 回顾性分析2017年7月~2020年7月在武汉科技大学附属孝感医院接受CMR检查的DCM老年患者173例,将患者按6:4的比例随机分为训练集(n=104)及测试集(n=69)。通过LASSO回归及多因素Cox回归筛选潜在预测因子,以此构建DCM患者MACE列线图预测模型。通过校准曲线、ROC曲线、决策曲线分析法、Kaplan-Meier生存分析对列线图模型进行评估及验证。结果 中位随访时间为29.7(16.4,45.4)月。随访结束时,59例(34.1%)患者发生MACE。LASSO回归及交叉验证筛选出9个潜在预测因子。多因素Cox回归分析结果显示,纽约心功能分级Ⅲ~Ⅳ级、N末端-脑钠肽前体、β受体阻断药、CMR晚期钆增强、左心室整体纵向应变是DCM患者发生MACE风险因子,并以此构建列线图预测模型。在训练集和测试集中,校准图显示列线图预测1年、3年生存率与实际生存率一致性较好。训练集1年、3年生存预测ROC曲线下面积分别为0.850(95%CI:0.748~0.953)、0.853(95%CI:0.797~0.909),测试集1年、3年生存预测ROC曲线下面积分别为0.858(95%CI:0.758~0.959)、0.887(95%CI:0.816~0.958)。决策曲线分析结果显示列线图模型的临床净获益率较高。Kaplan-Meier生存分析结果示,预测模型高风险组患者较低风险组生存概率降低(P<0.05)。结论 本研究通过临床和CMR特征参数构建了DCM老年患者MACE发生列线图预测模型,该模型具有较好校准度、区分度及临床应用价值。 展开更多
关键词 心脏磁共振 列线图 扩张型心肌病 晚期钆增强
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心脏磁共振对扩张型心肌病患者左心室逆重构的评估价值
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作者 吴鹏 张海波 +4 位作者 任平 赵鑫 杜雪 周梦迪 陈元国 《心脑血管病防治》 2024年第5期27-31,共5页
目的探讨心脏磁共振(CMR)对扩张型心肌病(DCM)患者左心室逆重构(LVRR的评估价值。方法选择2017年6月至2020年6月在雅安市人民医院诊治的DCM患者112例,所有入组患者均行冠状动脉计算机断层血管造影(CTA)或者选择性冠状动脉造影排除冠心病... 目的探讨心脏磁共振(CMR)对扩张型心肌病(DCM)患者左心室逆重构(LVRR的评估价值。方法选择2017年6月至2020年6月在雅安市人民医院诊治的DCM患者112例,所有入组患者均行冠状动脉计算机断层血管造影(CTA)或者选择性冠状动脉造影排除冠心病,并完成24 h动态心电图检查、超声心动图检查以及晚期钆增强-心脏磁共振(LGE-CMR),然后根据指南给予最佳药物治疗(OMT),随访12个月记录相关数据,包括入组患者的一般资料、超声心动图参数、LVRR、LGE变化(△LGE评分)、左心室射血分数(LVEF)变化(△LVEF)以及心脏事件,分析LGE指标与LVRR之间的相关性。结果112例DCM患者中,28例患者(25%)在随访中出现LVRR,这些患者在基线时心率和收缩压均更高,NYHA心功能分级更差(χ^(2)=3.357、2.161、35.012,P<0.01)。有LVRR的患者LGE阳性率和LGE评分较无LVRR患者低(χ^(2)/t=5.829、2.831,P<0.05)。有LVRR患者的△LGE评分(-3.1±2.7)%低于无LVRR患者的△LGE评分(4.4±2.1)%,差异有统计学意义(t=7.343,P<0.01)。随访期间△LVEF与△LGE评分呈负相关(r=-0.781,P<0.01)。多因素分析显示,LGE阳性、基线LGE评分及△LGE评分为LVRR的保护因素(OR=0.233、0.773、0.901,P<0.05)。LGE阳性患者心脏事件发生率明显高于LGE阴性患者(χ^(2)=47.998,P<0.05);发生心脏事件的患者基线时的LGE评分和△LGE评分均高于未发生心脏事件的患者(t=26.960、14.930,P<0.01)。结论在DCM患者中,基线时的LGE阳性及评分和△LGE评分为LVRR的保护因素,LGE阳性患者心脏事件发生率明显高于LGE阴性患者,通过随访CMR,有助于个体化治疗策略的早期制定。 展开更多
关键词 扩张型心肌病 心脏磁共振 左心室逆重构 晚期钆增强
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心脏磁共振在左心房评估中的应用 被引量:1
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作者 张新娜 侯唯姝 +4 位作者 俞宏林 赵玲玲 杨盼盼 蒋雨琦 李小虎 《中国医学影像学杂志》 CSCD 北大核心 2024年第1期100-104,共5页
作为左心室的延续,左心房与左心室相互影响,在整个心脏的功能中发挥重要作用。目前评估心房结构及功能的技术很多,但是由于左心房结构复杂且心肌较薄,给相关评估带来了一定挑战。本文从心肌应变、延迟强化方面介绍左心房评估的参数、评... 作为左心室的延续,左心房与左心室相互影响,在整个心脏的功能中发挥重要作用。目前评估心房结构及功能的技术很多,但是由于左心房结构复杂且心肌较薄,给相关评估带来了一定挑战。本文从心肌应变、延迟强化方面介绍左心房评估的参数、评估过程中的注意事项及相关临床应用。 展开更多
关键词 纤维化 心肌应变 心脏磁共振 左心房 延迟强化 综述
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多模态影像对STEMI患者急诊PCI术后MACE的预测价值
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作者 陈思 陈允安 +4 位作者 张洁 周莹 李明珠 龚晓璇 刘琨 《南京医科大学学报(自然科学版)》 CAS 北大核心 2024年第11期1525-1533,1549,共10页
目的:探讨三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)、心肌做功(myo-cardial work,MW)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉... 目的:探讨三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)、心肌做功(myo-cardial work,MW)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)术后主要不良心血管事件(major adverse cardiovascular event,MACE)发生的预测价值。方法:纳入90例行PPCI的首次STEMI患者,术后24 h内行3D-STE、MW检查,术后7 d内完善心脏磁共振晚期钆增强成像(cardiac magnetic resonance late gadolinium enhancement imaging,CMR-LGE)检查,随访12个月MACE(再发心绞痛、因急性冠脉综合征行血运重建、急性心衰发作、心源性猝死)的发生情况。结果:20例(22.2%)患者发生MACE,单因素及多因素Cox回归分析显示梗死面积(infarction size,IS)、整体纵向应变(global longitudinal strain,GLS)、整体做功指数(global work index,GWI)为预测MACE发生的独立参数,受试者工作特征(receiver operating characteristic,ROC)曲线显示上述指标的曲线下面积(area under the curve,AUC)分别为0.886、0.846、0.830,Delong法两两比较显示AUC值差异无统计学意义(P均>0.05)。联合GLS和GWI预测MACE发生的AUC值达0.939,显著优于GLS及GWI单一参数(P均<0.05),且与IS相当(P>0.05)。Kaplan-Meier曲线表明GLS<-10.5%、GWI>1298.5 mmHg%、IS<26.05%的患者有更高的生存率(P<0.05)。结论:3D-STE及MW能较好地预测STEMI患者PPCI术后MACE的发生,其中GLS及GWI诊断价值相似,二者联合优于单一指标,且与IS诊断效能相当。 展开更多
关键词 急性ST段抬高型心肌梗死 主要不良心血管事件 三维斑点追踪超声心动图 心肌做功 心脏磁共振晚期钆增强成像
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心脏延迟增强MRI不同TI值对心肌梗死诊断效能的影响
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作者 陆虹宇 杨映霞 +3 位作者 黄涛 蒋平平 崔盟 林华 《放射学实践》 CSCD 北大核心 2024年第4期473-478,共6页
目的:通过与TI值为300 ms的常规相位敏感反转恢复(PSIR)序列进行比较,探讨调整TI值为左室血池过零时PSIR序列心脏延迟增强MRI对心肌梗死的诊断效能。方法:将2022年3月-2022年12月在本院确诊为心肌梗死的35例患者纳入本研究。所有患者在... 目的:通过与TI值为300 ms的常规相位敏感反转恢复(PSIR)序列进行比较,探讨调整TI值为左室血池过零时PSIR序列心脏延迟增强MRI对心肌梗死的诊断效能。方法:将2022年3月-2022年12月在本院确诊为心肌梗死的35例患者纳入本研究。所有患者在静脉注射Gd-DTPA后10 min分别采用300 ms和血液过零时的TI值行PSIR序列延迟增强(LGE)扫描,扫描平面包括两腔心、四腔心及通过病变区的短轴位。测量并比较2种TI值LGE图像上正常心肌、心肌疤痕与心腔内血液的SNR、CNR和信号强度(SI)的差异及心肌梗死范围的差异。结果:调整TI后LGE图像上心肌疤痕区域与左心室血池的CNR[24.58(16.80,48.51)vs.11.83(5.04,22.73),Z=-6.87,P<0.05]更高,并能显示更大的梗死面积[4.20(2.10,7.55)mm^(2) vs.3.45(1.40,6.15)mm^(2),Z=-6.65,P<0.05],且有更高的疤痕-血池信号强度差[366.80(258.75,432.60)vs.175.90(73.30,259.35),Z=-8.13,P<0.05],更低的正常心肌-血池信号强度差[284.70(196.05,405.20)vs.511.20(394.55,636.70),Z=-8.07,P<0.01]。结论:调整TI后的PSIR序列心脏延迟增强扫描可以有效抑制心腔内血池信号,提高心肌疤痕与血池的对比,而且心内膜下和乳头肌的强化更明显而显示更清晰,从而可提高对梗死区域内心肌活性的检测敏感度。 展开更多
关键词 心肌梗死 相位敏感反转恢复序列 磁共振成像 延迟强化 反转时间
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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
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作者 徐亚威 韩彬 +2 位作者 许浩杰 孟圆 杨海波 《中国循证心血管医学杂志》 2024年第3期312-315,共4页
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... 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。 展开更多
关键词 围产期心肌病 心肌磁共振成像 钆延迟强化
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三维高分辨力磁共振钆延迟增强成像评估心房颤动患者左心房心肌纤维化的可行性研究
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作者 朱乐怡 袁硕 +7 位作者 王艺宁 安康 杨文静 李浩杰 尹刚 赵世华 陆敏杰 郑哲 《中国循环杂志》 CSCD 北大核心 2024年第7期703-709,共7页
目的:探讨三维高分辨力磁共振钆延迟增强成像(3D-LGE-MRI)评估心房颤动患者左心房心肌纤维化程度及空间分布特征的可行性。方法:回顾性收集2021年5月至2023年2月于中国医学科学院阜外医院行杂交心房颤动消融术前采用左心房3D-LGE-MRI评... 目的:探讨三维高分辨力磁共振钆延迟增强成像(3D-LGE-MRI)评估心房颤动患者左心房心肌纤维化程度及空间分布特征的可行性。方法:回顾性收集2021年5月至2023年2月于中国医学科学院阜外医院行杂交心房颤动消融术前采用左心房3D-LGE-MRI评估左心房心肌纤维化的心房颤动患者34例。2名放射诊断医师(医师1和医师2)双盲分别对图像质量进行4分法评价,均使用ADAS后处理软件测量左心房壁及钆延迟增强(LGE)面积,并计算LGE面积占比。其中1名医师再进行分区分析,将左心房壁分为10区,测量每个分区的心房壁面积及LGE面积,并计算LGE面积占比。使用Kappa检验评价医师1和医师2图像质量评分的一致性,采用组内相关系数评价LGE定量参数的观察者间一致性。另使用独立样本t检验或Mann-Whitney U检验比较持续性与阵发性心房颤动患者的左心房形态学参数、LGE程度及空间分布特征。结果:34例患者均完成左心房3D-LGE-MRI扫描并获得具有诊断价值图像。医师1和医师2对图像总体质量的主观评分分别为(2.88±0.64)分和(2.97±0.58)分,左心房壁清晰度的主观评分分别为(3.26±0.75)分和(3.24±0.70)分,Kappa值分别为0.724和0.859。LGE面积及LGE面积占比在观察者(医师1和医师2)间具有良好的一致性,组内相关系数达0.969和0.950。阵发性和持续性心房颤动患者间左心房壁LGE面积及LGE面积占比差异均无统计学意义(P均>0.05)。与阵发性心房颤动患者比,持续性心房颤动患者具有更高的犹他分期和更为严重的右下肺静脉及左心房间隔区域纤维化,差异均有统计学意义(P均<0.05)。结论:3D-LGE-MRI可应用于三维可视化及定量评估心房颤动患者的左心房心肌纤维化,可为心房颤动患者个体化治疗方案的制定提供参考。持续性心房颤动患者的左心房纤维化程度较阵发性心房颤动患者更严重,二者差异主要表现在右下肺静脉及左心房间隔区域。 展开更多
关键词 磁共振成像 心房颤动 钆延迟增强 心肌纤维化
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Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction 被引量:4
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作者 Loic Bière Marjorie Niro +4 位作者 Hervé Pouliquen Jean-Baptiste Gourraud Fabrice Prunier Alain Furber Vincent Probst 《World Journal of Cardiology》 CAS 2017年第3期268-276,共9页
AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational ... AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization. 展开更多
关键词 Ventricular tachycardia MYOCARDITIS myocardial infarction late gadolinium enhancement cardiac magnetic resonance myocardial infarction and nonobstructive coronary arteries
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射血分数降低的扩张型心肌病患者左心室逆重构的预测因素及预后研究 被引量:3
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作者 吴鹏 张海波 +4 位作者 任平 赵鑫 杜雪 周梦迪 邹礼华 《中国循环杂志》 CSCD 北大核心 2023年第4期421-426,共6页
目的:研究射血分数降低的扩张型心肌病(DCM)患者左心室逆重构(LVRR)的预测因素及预后。方法:纳入2017年12月至2020年12月雅安市人民医院心内科新诊断的射血分数降低的DCM患者82例,经过标准化的药物治疗后,根据LVRR标准分为发生LVRR组和... 目的:研究射血分数降低的扩张型心肌病(DCM)患者左心室逆重构(LVRR)的预测因素及预后。方法:纳入2017年12月至2020年12月雅安市人民医院心内科新诊断的射血分数降低的DCM患者82例,经过标准化的药物治疗后,根据LVRR标准分为发生LVRR组和未发生LVRR组。统计分析两组患者的一般资料,标准化的药物治疗前后左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)、钆对比剂延迟增强(LGE)阳性率、LGE评分及随访患者主要不良心脏事件(包括心力衰竭再住院、致死性心律失常和心原性死亡)发生率。Logistic回归分析LVRR的预测因素,采用Kaplan-Meier法进行生存分析。结果:82例DCM患者经过标准化的药物治疗后,39例(47.6%)患者发生LVRR,43例(52.4%)患者未发生LVRR。发生LVRR组的左束支阻滞(LBBB)发生率、心率、治疗前后LVEDD、LGE阳性率、LGE评分均低于未发生LVRR组(P均<0.05)。发生LVRR组经过标准化的药物治疗前后LVEF均显著高于未发生LVRR组(P均<0.01)。平均随访(21±7)个月。多因素Logistic回归分析显示,LVRR的预测因素为基线LVEF≥35%(OR=16.822,95%CI:1.848~153.156,P=0.012)和LGE阴性(OR=1.376,95%CI:1.110~1.708,P=0.031)。Kaplan-Meier生存曲线分析显示,与未发生LVRR组相比,发生LVRR组的累积主要不良心脏事件发生率低(log-rank P=0.0089)、累积生存率高(log-rank P=0.0186);与LGE阳性患者相比,LGE阴性患者的累积主要不良心脏事件发生率低(log-rank P<0.0001)、累积生存率高(log-rank P=0.0063)。结论:经过标准化的药物治疗后,有47.6%的射血分数降低的DCM患者出现LVRR。基线LVEF≥35%和LGE阴性的患者发生LVRR的可能性大,预后更好。 展开更多
关键词 扩张型心肌病 心脏磁共振成像 逆重构 钆对比剂延迟增强 预后
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心脏磁共振钆延迟增强灰血技术提高心肌梗死检出能力的应用 被引量:2
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作者 罗毅 黄璐 +4 位作者 乔金晗 杨朝霞 严祥虎 唐大中 夏黎明 《中国医学影像学杂志》 CSCD 北大核心 2023年第6期581-586,共6页
目的评估心脏磁共振钆延迟增强(LGE)灰血技术对心肌梗死的检出能力。资料与方法前瞻性收集2021年1月—2022年1月在华中科技大学同济医学院附属同济医院确诊为心肌梗死或心肌梗死复查患者50例,所有患者均行心脏磁共振LGE亮血和灰血技术扫... 目的评估心脏磁共振钆延迟增强(LGE)灰血技术对心肌梗死的检出能力。资料与方法前瞻性收集2021年1月—2022年1月在华中科技大学同济医学院附属同济医院确诊为心肌梗死或心肌梗死复查患者50例,所有患者均行心脏磁共振LGE亮血和灰血技术扫描,所有图像纳入本次评估范围。使用4点量表法对2种技术的图像质量和心肌梗死检出可信度进行评分,并比较2种技术的整体图像质量和心肌梗死检出可信度。分别比较LGE亮血和灰血技术图像的梗死心肌与左心室血池、梗死心肌与正常心肌、正常心肌和左心室血池的对比率(CR)和对比噪声比(CNR)。2名观察者对LGE灰血和亮血技术图像质量的评价以及CR和CNR的评价均进行一致性分析。结果LGE灰血与亮血技术图像质量评分差异无统计学意义(t=1.895,P=0.058),但是LGE灰血技术在心肌梗死检出可信度优于亮血技术(t=5.281,P<0.001)。图像客观定量分析中,与LGE亮血技术比较,LGE灰血技术的梗死心肌/血池的CNR和CR均较高(Z=3.113、3.606,P<0.01),而梗死心肌/正常心肌的CNR较低(Z=3.06,P=0.002)。2名观察者对LGE灰血和亮血技术的图像质量和心肌梗死检出可信度评分具有良好的一致性(Kendall's W均>0.7)。2名技师所测值计算得到的CR和CNR具有较好的一致性(ICC>0.7)。结论LGE灰血技术在保证高质量心脏磁共振图像的前提下,明显提高了梗死心肌与血池的对比,从而提高心肌梗死特别是心内膜下心肌梗死的检出能力,为临床心肌梗死随访提供可靠依据。 展开更多
关键词 心肌梗死 磁共振成像 钆延迟增强 灰血
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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 被引量:4
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作者 郭会军 陈会校 +3 位作者 李娟 张海军 赵沙沙 杨英焘 《岭南心血管病杂志》 CAS 2023年第1期35-40,共6页
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 gadoli... 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。 展开更多
关键词 肥厚型心肌病 心脏磁共振 心肌纤维化 晚期钆增强 关系
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