目的：运用心肌延迟对比增强（DCE）MRI评估肺高血压（PH）患者心肌受损程度及其对心功能的影响。材料与方法：经右心导管确诊并接受心脏MRI检查的PH患者60例，男8例，女52例；平均年龄（39.9±12.5）岁。通过快速稳态进动采集（FIESTA）图像，测量和计算右心室（RV）和左心室（LV）的容积（volumes）、射血分数（EF）、每搏输出量（SV）、心肌质量（MM）、室间隔-游离壁距离百分比（fractional-SFD）、三尖瓣环收缩期位移百分比（fractional-TAAD）、室间隔曲率（CIVS）及室间隔与左心室游离壁曲率的比值（RC）。容积、SV、MM经体表面积（BSA）校正。舒张末期RV MM与LV MM比值为心室质量指数（Ventricular mass index，VMI）。通过DCE图像观察和分析心肌DCE的位置及特点，并测量其质量。比较DCE阳性与DCE阴性PH患者的心功能参数。统计学方法采用t检验、U检验。结果：49例（81.67%）PH患者出现心肌DCE，均位于RV插入部（RVIP），其中12例（24.49%）局限于RVIP，37例（75.51%）延伸至室间隔（IVS）。前、下RVIP受累分别为48例（97.96%）、44例（89.79%），前、下RVIP均受累为43例（87.76%）。DCE均局限于心肌壁中层，DCE MM为（3.83±1.93）g，占RV MM与LV MM总和的2.88%（0.25%~6.50%）。DCE阳性较DCE阴性患者的RV ESVI、VMI显著升高（P=0.040，0.011）；RV EF、fractional-TAAD、CIVS及RC显著降低（P=0.002，0.001，0.023，0.001）。结论：心肌DCE可作为判断PH患者心功能受损严重程度的参考指标。
Abstract
Objective: To assess the extent of myocardial damage and its impact on cardiac function in patients with pulmonary hypertension(PH) using myocardial delayed contrast enhancement(DCE) MR imaging. Methods: Sixty patients with PH were confirmed by cardiac catheterization and all patients underwent MR imaging, 8 males and 52 females, aged (39.9±12.5) years. Right ventricle(RV) and left ventricle(LV) volumes, ejection fraction(EF), stroke volume(SV), mass, fractional distance change from septum to free-wall(fractional-SFD), fractional tricuspid annulus apex distance change(fractional-TAAD), curvature of interventricular septum(CIVS), and curvature ratio(RC) were obtained by steady-state free precession sequence(FIESTA) images. RV and LV volumes, SV, mass were corrected by body surface area(BSA). Ventricular mass index(VMI) was the ratio of RVMM and LVMM. DCE images were post-processed for calculating DCE MM. Location and characteristics of myocardial DCE were also observed and analyzed. Independent Sample t-Test or Mann-Whitney U Test was used to compare the differences of ventricular function parameters in patients with and without DCE. Results: DCE was present in 49 patients(81.67%). DCE was confined to the RV insertion points(RVIPs) in 12 patients(24.49%), and extended into the interventricular septum(IVS) in 37 patients(75.51%). DCE was present both anterior and inferior in 43 patients(87.76%). DCE was limited to the mid-wall region of the ventricular myocardium. DCE MM was (3.83±1.93)g, 2.88%(0.25%~6.50%) of the total mass of both RV and LV. Compared with patients without DCE, RV ESVI and VMI of patients with DCE were significantly increased(P=0.040, 0.011), while RV EF, fractional-TAAD, CIVS and RC was significantly decreased(P=0.002, 0.001, 0.023, 0.001). Conclusion: Myocardial DCE can be used as a reference index to evaluate the severity of cardiac function damage in patients with PH.
关键词
高血压 /
肺性 /
心肌 /
磁共振成像
Key words
Hypertension, pulmonary /
Myocardium /
Magnetic resonance imaging
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基金
天津应用基础与前沿技术研究计划（14JCZDJC57000）；国家临床重点专科建设项目。
