心肌组织追踪技术定量评估扩张型心肌病左室心肌应变的磁共振研究

发布时间：2018-08-22 07:36

【摘要】：目的:利用磁共振组织追踪(MR tissue tracking,MR-TT)技术定量评价扩张型心肌病(Dilated Cardiomyopathy,DCM)患者的左室心肌应变。资料与方法:回顾性分析2012年5月~2015年10月在南昌大学第二附属医院收治的45例扩张型心肌病患者作为病变组(B组),其中男29例,平均年龄(47±16)岁。按MRI延迟增强扫描是否出现心肌强化,将45例DCM患者分为有强化的b1组和无强化的b2组,分别为28例和17例。25名健康志愿者作为对照组(A组),其中男17例,平均年龄(47±6)岁。所有研究对象均接受MRI扫描。扫描方位包括左室长轴四腔,左室长轴二腔和左室短轴。扫描序列包括相位稳态采集快速成像序列(FIESTA)和反转恢复快速梯度回波序列(IRFGR)。用Cvi42软件进行定量分析,获得心功能指标如下:左室射血分数(LVEF)、左室舒张末期容积(EDV)、左室收缩末期容积(ESV)及左室排出量(SV);左室心肌应变参数包括:整体径向应变峰值(GPSR)、整体环向应变峰值(GPSC)、整体纵向应变峰值(GPSL)、节段的径向应变峰值(PSR)、环向应变峰值(PSC)及纵向应变峰值(PSL)。采用SPSS 22.0软件对所有数据进行统计学分析。结果:与对照组比较,病变组患者的左室功能明显受损,其中LVEF和SV显著减低(P0.01),ESV和EDV明显增加(P0.01)。病变组左室GPSR、GPSC、GPSL均较对照组显著降低(P0.01)。两组的GPSR分别为7.99±6.25%和37.88±7.50%,P0.05;GPSC为-3.89±3.1%和14.38±1.86%,P0.01;GPSL为-3.87±3.6%和-11.85±2.2%,P0.05。GPSR、GPSC、GPSL与LVEF之间存在着良好的线性相关,其中GPSR与LVEF呈正相关(r=0.92,P0.01);GPSC、GPSL与LVEF呈负相关(r=-0.94,r=-0.90,P0.01);GPSR、GPSC、GPSL之间具有显著的相关性(GPSR vs.GPSC:r=-0.97,P0.01;GPSR vs.GPSL:r=-94 P0.01;GPSC vs.GPSL:r=0.97,P0.01)。对左室局部心肌应变分析,病变组左室心肌各节段(除AHA分段第17段心尖段外)PSR、PSC及PSL均较对照组减低,其中病变组第13节段PSL、第14节段PSC、第15节段PSL与对照组之间的差异无统计学意义(P=0.58;P=0.66;P=0.09),其它节段均存在统计学差异)(P0.05)。对照组室中部PSC大于基底部(-18.35±2.07%vs.-16.15±1.99%,P=0.84);病变组室中部PSC小于基底部(-3.70±1.64%vs.-6.44±1.53%,P0.01)。对照组的室间隔PSR、PSC、PSL均大于下壁PSR、PSC、PSL,且具有统计学差异(P0.05);病变组的室间隔PSR、PSC、PSL在前壁、室间隔、下壁、侧壁中最低,分别为7.00±4.14%、-4.40±0.91%和-3.13±0.65%,与其他各壁之间的差异具有统计学差异(P0.01)。结论:虽然DCM是心肌弥漫性改变的,但是受损程度是不均匀的,室间隔心肌的纵向、环向及径向应变受损最明显。MR-TT技术不仅能够从整体分析DCM左室心肌应变的变化,而且能从局部进行分析,可很好地用于评价DCM左室心肌受损的程度。
[Abstract]:Objective: to quantitatively evaluate the left ventricular strain in patients with Dilated cardiomyopathy by using Mr tissue tracing (MR tissue tracing MR-TT (MR-TT) technique. Materials and methods: Forty-five patients with dilated cardiomyopathy treated in the second affiliated Hospital of Nanchang University from May 2012 to October 2015 were retrospectively analyzed as group B (29 males with an average age of (47 卤16) years). According to MRI delayed enhancement scan or not, 45 patients with DCM were divided into two groups: group B 1 with enhanced enhancement and group B 2 with no enhancement. 28 cases and 17 healthy volunteers were used as control group (group A), 17 males with an average age of (47 卤6) years. All subjects underwent MRI scanning. Scanning azimuth included left ventricular long-axis four-chamber, left ventricular long-axis two-chamber and left ventricular short-axis. Scanning sequence includes phase steady state acquisition fast imaging sequence (FIESTA) and reverse recovery fast gradient echo sequence (IRFGR). Quantitative analysis was carried out with Cvi42 software. Cardiac function parameters were obtained as follows: left ventricular ejection fraction (LVEF),) left ventricular end-diastolic volume (EDV),) left ventricular end-systolic volume (ESV) and left ventricular ejection (SV);) left ventricular strain parameters including: global radial strain peak (GPSR), global circumferential strain peak Radial strain peak (PSR), circumferential strain peak (PSC) and longitudinal strain peak (PSL). Of (GPSC), whole longitudinal strain peak (GPSL), segment All the data were analyzed statistically by SPSS 22. 0 software. Results: compared with the control group, the left ventricular function in the lesion group was significantly impaired, and LVEF and SV were significantly decreased (P0.01) ESV and EDV were significantly increased (P0.01). The GPSL of GPSL in the left ventricular GPSRT GPSL in the lesion group was significantly lower than that in the control group (P 0.01). 涓ょ粍鐨凣PSR鍒嗗埆涓，

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