Chiribiri A, Leuzzi S, Conte M R, Bongioanni S, Bratis K, Olivotti L, De Rosa C, Lardone E, Di Donna P, Villa A D M, Cesarani F, Nagel E, Gaita F, Bonamini R
King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Internal Medicine, University of Torino, Italy.
Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy.
Clin Radiol. 2015 May;70(5):495-501. doi: 10.1016/j.crad.2014.12.018. Epub 2015 Feb 7.
To measure the prevalence of abnormal rest perfusion in a population of consecutive patients with known hypertrophic cardiomyopathy (HCM) referred for cardiovascular MRI (CMR), and to assess any associations between abnormal rest perfusion and the presence, pattern, and severity of myocardial scar and the presence of risk factors for sudden death.
Eighty consecutive patients with known HCM referred for CMR underwent functional imaging, rest first-pass perfusion, and late gadolinium enhancement (LGE).
Thirty percent of the patients had abnormal rest perfusion, all of them corresponding to areas of mid-myocardial LGE and to a higher degree of segmental hypertrophy. Rest perfusion abnormalities correlated with more extensive and confluent LGE. The subgroup of patients with myocardial fibrosis and rest perfusion abnormalities (fibrosis+/perfusion+) had more than twice the incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring in comparison to patients with myocardial fibrosis and normal rest perfusion (fibrosis+/perfusion-) and patients with no fibrosis and normal rest perfusion (fibrosis-/perfusion-).
First-pass perfusion CMR identifies abnormal rest perfusion in a significant proportion of patients with HCM. These abnormalities are associated with the presence and distribution of myocardial scar and the degree of hypertrophy. Rest perfusion abnormalities identify patients with increased incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring, independently from the presence of myocardial fibrosis.
测量连续入选的已知肥厚型心肌病（HCM）患者中静息灌注异常的患病率，并评估静息灌注异常与心肌瘢痕的存在、模式和严重程度以及猝死危险因素的存在之间的任何关联。
连续80例已知HCM且因心血管磁共振成像（CMR）而就诊的患者接受了功能成像、静息首过灌注和延迟钆增强（LGE）检查。
30%的患者存在静息灌注异常，所有这些异常均对应于心内膜下LGE区域和更高程度的节段性肥厚。静息灌注异常与更广泛和融合的LGE相关。与心肌纤维化且静息灌注正常（纤维化+/灌注-）以及无纤维化且静息灌注正常（纤维化-/灌注-）的患者相比，心肌纤维化且静息灌注异常（纤维化+/灌注+）的患者在动态心电图监测中发生非持续性室性心动过速发作的发生率高出两倍多。
首过灌注CMR可在相当比例的HCM患者中识别出静息灌注异常。这些异常与心肌瘢痕的存在和分布以及肥厚程度相关。静息灌注异常可识别出在动态心电图监测中非持续性室性心动过速发作发生率增加的患者，且与心肌纤维化的存在无关。
