肥厚性梗阻型心肌病与高血压左心室向心性肥厚患者的右室磁共振应变比较研究*

Diagnosing value of CMR in right Ventricular myocardium deformation of hypertrophic obstructive cardiomyopathy and left ventricular central hypertrophy of hypertension*

摘要:

目的 应用心血管磁共振（CMR）定量评价肥厚性梗阻型心肌病（HOCM）患者的右室局部及整体应变，并与高血压左心室向心性肥厚（H-LVCH）进行对比研究。方法 前瞻性纳入2014年7月—2017年12月 成都市第五人民医院78例患者，分为HOCM组（37例）和H-LVCH组（41例）。测量两组患者右心功能指标，包括室间隔（IVS）厚度、右室舒张末期长径（RVEDMD）、右室收缩末期长径（RVESMD）、右室长轴活动度（RVLAA）、右室舒张末最大面积（RVEDMA）、右室收缩末期最大面积（RVESMA）、右室最大面积变化率（RVCR）。结果 HOCM组病例IVS厚度大于H-LVCH组（P?<0.05）；HOCM组与H-LVCH组RVEDMD分别为（45.507±3.663）及（44.772±2.786）mm，两者比较，差异无统计学意义（P?>0.05）；但HOCM组的RVESMD和RVLAA与H-LVCH组比较，差异有统计学意义（P?<0.05）；HOCM组与H-LVCH组RVEDMA分别为（1?232.000±99.064）及（1?203.364±85.466）mm2，两者比较差异无统计学意义（P?>0.05）；但HOCM组右室的RVESMA和RVCR与H-LVCH组比较，RVESMARVCR差异有统计学意义（P?<0.05）。HOCM患者与H-LVCH患者RVLAA和RVCR鉴别诊断临界值分别为29.67%和49.87%（P?<0.05）。结论 应用CMR能有效评价HOCM右心功能及右室纵向活动度的改变，并有助于HOCM与H-LVCH两种疾病的鉴别诊断。

Abstract:

Objective To explore diagnostic value of CRM in right ventricular myocardium deformation of patients with hypertrophic obstructive cardiomyopathy (HOCM) and hypertensive left ventricular central hypertrophy (H-LVCH). Methods Totally 78 patients who were admitted in our hospital from July 2014 to December 2017 were enrolled into this prospective study. Patients were divided into two groups: HOCM (n?=?37) and H-LVCH (n?=?41). Dimensions of interventricular septum (IVS), end diastolic major dimension of right ventricle (RVEDMD), end systolic major dimension of right ventricle (RVESMD), right ventricular long axis activity (RVLAA?=?RVESMD/RVEDMD), end diastolic major area of right ventricle (RVEDMA), end systolic major area of right ventricle (RVESMA), right ventricular area changes rate (RVCR) were recorded. Results The thickness of IVS in HOCM group was significantly increased than that in H-LVCH group (P?< 0.05). RVEDMD and RVEDMA in HOCM group were comparable with those in H-LVCH group (P?> 0.05). Significant difference in RVLAA and RVESMA were identified between HOCM group and H-LVCH group (P?< 0.05). Sensitivity for the differential diagnosis of right ventricular long axis activity and right ventricular maximum area in HOCM patients and H-LVCH patients by CMR were 29.67% and 49.87%, respectively (P?< 0.001). Conclusions CMR effectively differentiates right heart function and right heart Longitudinal activity changes induced by HOCM or H-LVCH.