左室心肌致密化不全的磁共振表现及其与心功能关系的研究

发布时间：2018-09-07 17:53

【摘要】：背景:左室心肌致密化不全(Left Ventricular Non-compaction,LVNC)是一种以左室心肌内异常粗大的肌小梁网及深陷的隐窝,且隐窝与心室腔相通为特征的罕见的先天性心肌病。心脏磁共振(Cardiovascular Magnetic Resonance,CMR)具有较高的组织分辨率、大视野及“一站式”检查的特点,能更为准确地显示非致密化心肌的分布特征,实时动态地展示致密层及非致密层心肌在心动周期中的变化,相比于超声心动图更容易测试出隐窝内部的附壁血栓等。目的:探讨LVNC磁共振影像学特点,以及受累心肌节段与心脏收缩功能之间的关系。方法:收集2014年9月至2017年1月期间,在南昌大学第一附属医院就诊,并且经临床、超声心动图或CMR检查,确诊为LVNC的患者29例,所有患者均接受CMR检查。通过心功能专用分析软件评估左室射血分数(LVEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)。参照AHA的17节段法,,对患者左室心肌致密化不全累及的心肌节段进行计数,同时在舒张末期量测全部节段心肌的非致密化心肌(NC)和致密化心肌的(C)的厚度,同时计算二者的比值。对比LVNC病人和正常对照组间CMR的心功能参数值的差异,同时对左心室射血分值和受累节段数量、非致密化心肌和致密化心肌的厚度的比值(NC/C)等进行相关性分析。结果:29例符合LVNC诊断的患者,心肌致密化不全的心肌节段为192节段,占所有节段的39%,平均每个LVNC患者的非致密化心肌节段数为6.4±3.1,非致密化心肌与致密化心肌厚度的比值平均为2.9±0.8。所有患者心尖帽部均可见心肌致密化不全,除去心尖部之外,节段数从多到少分别是侧壁尖部(99%)、间壁尖部(98%)、及前壁尖部(87%),而室间隔基底段均不符合心肌致密化不全。两组之间CMR基本参数(NC/C、致密层心肌厚度、心肌致密化不全节段数、LVEF、LVESV及LVEDVI都有显著性差异。LVNC病人射血分数与致密化不全标准的心肌节段数目及NC/C均值呈负相关。结论:1、CMR可以将每个心动周期中致密化不全心肌的分层特征表现的动态过程准确、清晰展示。2、致密化不全心肌最常见部位为心尖部,另外是近心尖部、左心室侧壁与前壁,而室间隔基底段都没有出现累及。3、LVNC患者与健康对照组之间,CMR 6组参数(NC/C、C、心肌致密化不全节段均数、射血分数(LVEF)、LVESV及LVEDVI都有显著差别性,其中心肌致密化不全节段平均数两组之间具有显著差异。4、LVNC患者经CMR测定的射血分数与符合致密化不全标准的心肌节段数目及致密化不全的心肌节段的NC/C均值呈负相关。
[Abstract]:Background: left ventricular myocardial densification (Left Ventricular Non-compaction,LVNC) is a rare congenital cardiomyopathy characterized by abnormal trabecular reticulum and deep recess in left ventricular myocardium. Cardiac magnetic resonance (Cardiovascular Magnetic Resonance,CMR) has high tissue resolution, large field of vision and "one-stop" examination, and can more accurately display the distribution of noncompact myocardium. Compared with echocardiography, it is easier to detect the mural thrombus inside the crypt by displaying the changes of the dense and non-compact myocardium in the cardiac cycle in real time and dynamically. Objective: to investigate the MRI features of LVNC and the relationship between the involved myocardial segment and cardiac systolic function. Methods: from September 2014 to January 2017, 29 patients with LVNC were enrolled in the first affiliated Hospital of Nanchang University. All the patients were examined with CMR after clinical, echocardiographic or CMR examinations. Evaluation of left ventricular ejection fraction (LVEF),) by cardiac function analysis software (LVEDV), left ventricular end-diastolic volume (LVESV). According to the 17 segments method of AHA, the myocardial segments of patients with incomplete densification of left ventricular myocardium were counted, and the thickness of (NC) and (C) in all segments of myocardium were measured at the end of diastole. The ratio of the two is calculated at the same time. To compare the difference of cardiac function parameters between LVNC patients and normal controls, and to analyze the correlation between left ventricular ejection score (LVEF) and the number of involved segments, and the ratio of thickness of non-densified myocardium to densified myocardium (NC/C). Results in 29 patients with LVNC, the number of nondensified myocardial segments was 192.The average number of non-densified myocardial segments per LVNC patient was 6.4 卤3.1, and the ratio of non-densified myocardium to densified myocardial thickness was 2.9 卤0.8. Myocardial densification was found in the apical cap of all patients. Except for the apical part of the heart, the number of segments from more to less was the apical part of lateral wall (99%), the apical part of interwall (98%), and the apical part of anterior wall (87%), but the basal segment of ventricular septum did not accord with myocardial densification. There were significant differences in the basic parameters of CMR between the two groups (the thickness of the compact layer of NC/C, the number of incomplete segments of myocardial densification, the number of LVEF, LVESV and LVEDVI). The ejection fraction was negatively correlated with the number of myocardial segments and the mean value of NC/C. Conclusion the dynamic process of the delamination characteristics of densified incomplete myocardium in each cardiac cycle can be accurately and clearly displayed by: 1 / 1 CMR. The most common site of densified incomplete myocardium is apical, proximal, lateral and anterior wall of left ventricle. However, there were no significant differences in the parameters of CMR6 between the patients with ventricular septal basal segment and the healthy control group (mean number of NC/C,C, myocardial densification, ejection fraction (LVEF), LVESV and LVEDVI), and there was no significant difference between the patients with ventricular septal basal segment and the healthy control group (P > 0.05). There was significant difference between the two groups in the average number of myocardial densification segments. The ejection fraction measured by CMR was negatively correlated with the number of myocardial segments in accordance with the criteria of myocardial densification and the NC/C mean of myocardial segments with incomplete densification.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.2;R445.2

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