Xu Hua-yan, Yang Zhi-gang, Sun Jia-yu, Wen Ling-yi, Zhang Ge, Zhang Shuai, Guo Ying-kun
Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Eur J Radiol. 2014 Apr;83(4):665-72. doi: 10.1016/j.ejrad.2014.01.008. Epub 2014 Jan 16.
To assess regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction using 3.0-T cardiac magnetic resonance (CMR) first-pass perfusion imaging.
Forty-two HCM patients, including 25 HCM patients with left ventricular outflow tract obstruction (HOCM), 17 HCM patients without left ventricular outflow tract obstruction (NOHCM), and 14 healthy subjects underwent CMR. The left ventricular (LV) function, left ventricular end-diastolic wall thickness (EDTH), and diameter of left ventricular outflow tract (LVOT) were measured and calculated. Based on the signal-time curve of the first-pass myocardium perfusion imaging, perfusion parameters including upslope, time to peak, and peak intensity, were assessed and compared by using one-way analysis of variance and independent t tests.
On the first-pass perfusion imaging, lower upslope and peak intensity and longer time to peak were found in HCM patients compared with normal subjects (all p<0.05). In contrast to the NOHCM group, the average time to peak of the HOCM group was increased (13.30 ± 4.82 s vs 16.28 ± 4.90 s, p<0.05), but first-pass perfusion upslope was reduced (4.96 ± 2.55 vs 2.58 ± 0.77, p<0.05). According to the bull's-eye model, the HOCM group's average thickness of basal segments was thicker than the NOHCM group, especially the anteroseptal, inferolateral, and anterior wall values, with a corresponding lower first-pass perfusion upslope than the NOHCM group (all p<0.05). A significant correlation was observed between first-pass perfusion upslope and LV EDTH (r=-0.551, p<0.001) and LVOT diameter (r=0.472, p<0.001).
The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction can be detected with first-pass perfusion CMR imaging.
使用3.0-T心脏磁共振（CMR）首过灌注成像评估有或无左心室流出道梗阻的肥厚型心肌病（HCM）患者的局部心肌微血管功能障碍差异。
42例HCM患者，包括25例有左心室流出道梗阻的HCM患者（HOCM）、17例无左心室流出道梗阻的HCM患者（NOHCM）以及14名健康受试者接受了CMR检查。测量并计算左心室（LV）功能、左心室舒张末期壁厚（EDTH）和左心室流出道（LVOT）直径。基于首过心肌灌注成像的信号-时间曲线，采用单因素方差分析和独立t检验评估并比较包括上升斜率、达峰时间和峰值强度在内的灌注参数。
在首过灌注成像中，与正常受试者相比，HCM患者的上升斜率和峰值强度较低，达峰时间较长（均p<0.05）。与NOHCM组相比，HOCM组的平均达峰时间增加（13.30±4.82秒对16.28±4.90秒，p<0.05），但首过灌注上升斜率降低（4.96±2.55对2.58±0.77，p<0.05）。根据靶心模型，HOCM组基底节段的平均厚度比NOHCM组厚，尤其是前间隔、下外侧和前壁的值，且相应的首过灌注上升斜率低于NOHCM组（均p<0.05）。首过灌注上升斜率与LV EDTH（r=-0.551，p<0.001）和LVOT直径（r=0.472，p<0.001）之间存在显著相关性。
通过首过灌注CMR成像可以检测有或无左心室流出道梗阻的肥厚型心肌病（HCM）患者的局部心肌微血管功能障碍差异。
