肥厚型心肌病患者左心室流出道梗阻与左心室形态的关系：一项心脏磁共振成像研究。

Relation between left ventricular outflow tract obstruction and left ventricular shape in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study.

机构信息

Department of Cardiology, Rangueil University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Cardiac Imaging Center, University Hospital of Toulouse, Toulouse, France.

出版信息

Arch Cardiovasc Dis. 2013 Aug-Sep;106(8-9):440-7. doi: 10.1016/j.acvd.2013.05.002. Epub 2013 Jul 29.

DOI:10.1016/j.acvd.2013.05.002

PMID:23906680

Abstract

BACKGROUND

Hypertrophic cardiomyopathies (HCM) are often associated with left ventricular (LV) outflow tract obstruction, which can explain symptoms and impact prognosis.

AIMS

To better understand the mechanisms that link obstruction and LV shape in HCM.

METHODS

Patients with HCM who underwent cardiac magnetic resonance (CMR) imaging were included retrospectively. Obstructive HCM was defined as LV outflow gradient more than 30 mm Hg at rest by transthoracic echocardiography. The LV shape and mitral angle were assessed by CMR. Results were compared with control subjects.

RESULTS

Mean LV-mitral angle was smaller in patients with obstructive HCM (n=29) than in patients with non-obstructive HCM (n=15) or control subjects (n=15) (80 ± 5° vs 87 ± 7° [P=0.0002] and 89 ± 2° [P<0.0001]). Mean mitral papillary muscles angle was greater in patients with non-obstructive HCM than in patients with obstructive HCM or control subjects (136 ± 17° vs 123 ± 16° [P=0.007] and 118 ± 10° [P=0.002]). Patients with non-obstructive HCM had a greater mean LV-aortic root angle than patients with obstructive HCM or control subjects (139 ± 6° vs 135 ± 7° [P=0.04] and 133 ± 7° [P=0.03]).

CONCLUSION

There is a relation between morphological and functional parameters in HCM within which the mitral valve is probably part of pathophysiogenesis.

摘要

背景

肥厚型心肌病（HCM）常伴有左心室（LV）流出道梗阻，这可以解释其症状并影响其预后。

目的

更好地理解 HCM 中梗阻与 LV 形态之间的关联机制。

方法

回顾性纳入接受心脏磁共振（CMR）成像的 HCM 患者。经胸超声心动图检查发现静息状态下 LV 流出道梯度>30mmHg 时诊断为梗阻性 HCM。通过 CMR 评估 LV 形态和二尖瓣夹角。将结果与对照组进行比较。

结果

与非梗阻性 HCM 患者（n=15）或对照组（n=15）相比，梗阻性 HCM 患者（n=29）的 LV-二尖瓣夹角更小（80±5° vs 87±7°，P=0.0002；89±2°，P<0.0001）。非梗阻性 HCM 患者的二尖瓣瓣叶乳头肌夹角大于梗阻性 HCM 患者或对照组（136±17° vs 123±16°，P=0.007；118±10°，P=0.002）。非梗阻性 HCM 患者的 LV-主动脉根部夹角大于梗阻性 HCM 患者或对照组（139±6° vs 135±7°，P=0.04；133±7°，P=0.03）。