1.5T心脏磁共振技术在评价扩张型心肌病中的应用价值

发布时间：2018-05-16 19:54

本文选题：扩张型心肌病 + 心脏磁共振成像　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:采用1.5T心脏磁共振技术(CMRI)获得心脏左心室的多项结构和功能参数评价扩张型心肌病患者的整体心功能,初步探讨1.5T MRI在心血管疾病中的应用价值。方法:收集扩张型心肌病患者共40例及正常对照组共25例,对40例扩张型心肌病患者及25例正常对照组进行心脏磁共振检查,或得左心室的收缩末期容积、舒张末期容积及射血分数,收缩末期内径及舒张末期内径,左心室收缩末期及舒张末期球形指数。并对扩心病患者及正常对照组进行同期血浆脑钠肽测定和纽约心功能分级。1.比较两组间左心室各项结构和功能参数的改变,分析扩心病患者左心室各项结构和功能参数间的相关性。2.利用左心室结构及功能参数对扩心病患者的诊断价值绘制ROC曲线,评价其对扩心病诊断价值。3.分析扩心病患者左心室功能参数与纽约心功能分级的相关性。4.分析扩心病患者左心室功能参数与血浆脑钠肽的相关性。5.分析扩心病患者血浆脑钠肽与纽约心功能分级的相关性。6.分析扩心病患者主要的磁共振影像学表现。结果:1.扩心病患者左心室各项结构和功能参数具有良好的相关性,所有结构及功能参数对扩心病都有较高的诊断价值。2.扩心病患者左室射血分数随纽约心功能分级逐级升高呈降低表现,Spearman相关性分析表明左室射血分数与纽约心功能分级存在负相关关系(r=-0.493,P=0.001)。3.Spearman相关性分析表明扩心病患者左室射血分数与Lg BNP存在负相关关系(r=-0.513,P=0.001)。4.Spearman相关性分析表明扩心病患者Lg BNP与纽约心功能分级存在正相关关系(r=0.568,P=0.000)。5.扩心病患者中31例(77.5%)出现心肌延迟强化,表现为左心室心内膜下和(或)中层心肌斑片状、线条状强化,共计231个节段,其中发生部位以间隔壁的基底段及中段最为为主。结论:心脏磁共振成像技术是测量左心室结构及功能参数的“金标准”,应用1.5T MRI评价扩张型心肌病患者的心功能是可行的。CMRI能够直观的显示扩张型心肌病患者的心脏形态大小、心功能、病变的部位、范围和程度,综合分析CMRI各项结构和功能参数,联合临床心功能NAYA分级及血浆标志物如血浆脑钠肽等,可以准确、全面地评价扩张型心肌病,为临床治疗及预后提供有效依据。
[Abstract]:Objective: to evaluate the global cardiac function of patients with dilated cardiomyopathy (DCM) by 1.5T cardiac magnetic resonance technique (CMRI) and to evaluate the value of 1.5T MRI in cardiovascular disease. Methods: 40 cases of dilated cardiomyopathy and 25 cases of normal control group were collected, 40 cases of dilated cardiomyopathy and 25 cases of normal control group were examined by magnetic resonance imaging, or left ventricular end-systolic volume was obtained. End diastolic volume and ejection fraction, end-systolic diameter and end-diastolic diameter, left ventricular end-systolic and end-diastolic spherical index. The plasma brain natriuretic peptide (BNP) and cardiac function grading (NYHA) were measured in patients with dilated heart disease and normal control group. To compare the structural and functional parameters of left ventricle between the two groups, and to analyze the correlation between the structure and function parameters of left ventricle in patients with dilated heart disease. The diagnostic value of left ventricular structure and function parameters in patients with dilated heart disease was drawn by drawing ROC curve to evaluate the diagnostic value of .3in patients with dilated heart disease. To analyze the correlation between left ventricular function parameters and New York cardiac function grading in patients with dilated heart disease. To analyze the correlation between left ventricular function parameters and plasma brain natriuretic peptide (BNP) in patients with dilated heart disease. To analyze the correlation between plasma brain natriuretic peptide (BNP) and New York cardiac function grade. The main MRI findings of patients with dilated heart disease were analyzed. The result is 1: 1. The parameters of left ventricular structure and function in patients with dilated heart disease have good correlation. All the parameters of structure and function have high diagnostic value. 2. The results of Spearman correlation analysis showed that there was a negative correlation between left ventricular ejection fraction (LVEF) and cardiac function grading in New York heart disease patients. 3. Spearman correlation analysis showed that there was a negative correlation between left ventricular ejection fraction (LVEF) and New York cardiac function grading. 3. Spearman correlation analysis showed that DHD patients had a negative correlation with LVEF. There was a negative correlation between left ventricular ejection fraction (LVEF) and LG BNP. 4. Spearman correlation analysis showed that there was a positive correlation between LG BNP and New York cardiac function grading. In 31 patients with dilated heart disease (77.5%), delayed enhancement was found in the left ventricular subendocardial and / or middle myocardial plaques, with a total of 231 segments, in which the basal segment and the middle segment of the left ventricular subendocardium were the most common. Conclusion: cardiac magnetic resonance imaging is the gold standard for measuring the parameters of left ventricular structure and function. It is feasible to evaluate the cardiac function of patients with dilated cardiomyopathy by 1.5T MRI. CMRI can directly display the size of the heart, the heart function, the location, the extent and the degree of the lesion. The structure and function parameters of CMRI are analyzed synthetically. The combination of clinical cardiac function NAYA classification and plasma markers such as plasma brain natriuretic peptide can accurately and comprehensively evaluate dilated cardiomyopathy and provide effective basis for clinical treatment and prognosis.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.2;R445.2

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