摘要
目的采用四维血流(four-dimensional flow,4D Flow)心脏磁共振成像(cardiac magnetic resonance,CMR)技术对肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者是否存在左心室舒张功能障碍进行评估,探讨心肌纤维化对HCM患者左心室舒张功能的影响。材料与方法前瞻性纳入44例HCM患者,根据患者是否合并晚期钆增强(late gadolinium enhancement,LGE)分为HCM LGE(+)组(25例)和HCM LGE(-)组(19例),同期纳入31例健康对照者。三组人群进行3.0 T磁共振稳态自由进动序列及4D Flow序列扫描。采用CVI42后处理软件进行分析,包括心功能参数、二尖瓣血流速度参数。使用单因素方差分析或Mann-Whitney U检验对三组受试者临床资料及影像学参数进行比较;并对二尖瓣水平舒张早期平均血流速度(E)与舒张期整体室壁峰值厚度(global peak wall thickness,GPWT)、左心室质量(left ventricular mass,LVmass)进行相关性分析。结果HCM患者的LVmass及GPWT均大于健康对照组,且伴有心肌纤维化较不伴有心肌纤维化的HCM患者的GPWT增大更加明显[HCM LGE(+)组vs.HCM LGE(-)组vs.健康对照组];[LVmass:157.34(122.24,194.38)g vs.148.29(131.79,189.83)g vs.85.73(73.00,94.02)g;GPWT:20.04(16.76,24.99)mm vs.17.46(16.19,19.99)mm vs.9.47(8.35,10.92)mm](P<0.001);伴有心肌纤维化的HCM患者舒张早期平均血流速度峰值(E峰)低于不伴有心肌纤维化的HCM患者,且均较健康对照组低[HCM LGE(+)组vs.HCM LGE(-)组vs.健康对照组:(30.03±11.33)cm/s vs.(38.05±12.03)cm/s vs.(47.44±10.82)cm/s](P<0.001);而舒张晚期平均血流速度峰值(A峰)在三组间均无显著性差异;且伴有心肌纤维化的HCM患者较健康对照组的E/A值明显减低(1.10±0.61 vs.1.74±0.85)(P<0.05)。舒张期早期二尖瓣水平的平均血流速度与GPWT和LVmass均呈负相关(r=-0.593/r=-0.371,P<0.001/P=0.001)。结论基于4D Flow CMR不仅可以从三维角度对血流速度进行准确测量,同时能从血流动力学方面定量评估HCM患者的左室舒张功能障碍及心肌纤维化对HCM患者左心室舒张功能的影响。
Objective:Four-dimensional flow(4D Flow)cardiac magnetic resonance(CMR)technology was used to evaluate the presence of left ventricular diastolic dysfunction in patients with hypertrophic cardiomyopathy(HCM),and the effect of myocardial fibrosis on left ventricular diastolic function in HCM patients was explored.Materials and Methods:A total of 44 HCM patients were prospectively enrolled,and they were divided into HCM late gadolinium enhancement(LGE)(+)group(25 cases)and HCM LGE(−)group(19 cases)according to whether the patients had LGE,and 31 healthy controls were included in the same period.All three groups underwent 3.0 T magnetic resonance imaging,including steady-state free precession sequences and 4D Flow CMR scans.Analysis using CVI42 post-processing software included cardiac functional parameters and mitral valve blood flow velocity parameters.Clinical and imaging parameters were compared among the three groups using one-way analysis of variance or Mann-Whitney U test.Correlation analysis was performed between early diastolic mean blood flow velocity(E)and cardiac functional parameters.Results:The left ventricular mass(LVmass)and global peak wall thickness(GPWT)of HCM patients were greater than those of healthy controls,and the GPWT of HCM patients with myocardial fibrosis increased more significantly than that of HCM patients without myocardial fibrosis[HCM LGE(+)group vs.HCM LGE(−)group vs.healthy control group];[LVmass:157.34(122.24,194.38)g vs.148.29(131.79,189.83)g vs.85.73(73.00,94.02)g;GPWT:20.04(16.76,24.99)mm vs.17.46(16.19,19.99)mm vs.9.47(8.35,10.92)mm](P<0.001);The peak early diastolic mean blood flow velocity(peak E)of HCM patients with myocardial fibrosis was lower than that of HCM patients without myocardial fibrosis,and was lower than that of healthy control group[HCM LGE(+)group vs.HCM LGE(−)group vs.healthy control group:(30.03±11.33)cm/s vs.(38.05±12.03)cm/s vs.(47.44±10.82)cm/s](P<0.001),while there was no significant difference in the peak value of mean blood flow velocity(peak A)in late diastolic period between the three groups,and the E/A value of HCM patients with myocardial fibrosis was significantly lower than that of the healthy control group(1.10±0.61 vs.1.74±0.85)(P<0.05).The mean blood flow velocity at the mitral valve level in early diastolic was negatively correlated with GPWT and LVmass(r=−0.593/r=−0.371,P<0.001/P=0.001).Conclusions:Based on 4D Flow CMR,it can not only accurately measure the blood flow velocity from a three-dimensional perspective,but also quantitatively evaluate the effects of left ventricular diastolic dysfunction and myocardial fibrosis on the left ventricular diastolic function of HCM patients from the hemodynamic aspect.
作者
郑琰
马丽荣
郭家璇
张怀榕
孙潇
孙凯
王一帆
朱力
ZHENG Yan;MA Lirong;GUO Jiaxuan;ZHANG Huairong;SUN Xiao;SUN Kai;WANG Yifan;ZHU Li(The First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,General Hospital of Ningxia Medical University,Yichuan 750004,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2024年第5期119-125,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
国家重点研发计划项目(编号:2022YFC2010000)
中央引导地方科技发展资金项目(编号:2023FRD05010)。
关键词
肥厚型心肌病
心肌纤维化
左室舒张功能
四维血流心脏磁共振
磁共振成像
hypertrophic cardiomyopathy
myocardial fibrosis
left ventricular diastolic function
four-dimensional flow cardiac magnetic resonance
magnetic resonance imaging
