Zhang Yuting, He Ling, Cai Jinhua, Lv Tiewei, Yi Qijian, Xu Yang, Liu Lingjuan, Zhu Jing, Tian Jie
Department of Radiology, Children's Hospital, Chongqing Medical University, Chongqing, PR China.
Cardiology. 2015;131(4):245-50. doi: 10.1159/000381418. Epub 2015 May 12.
Cardiomyopathies are common cardiovascular diseases in children. Cardiac magnetic resonance imaging (cMRI) and echocardiography (Echo) are routinely applied in the detection and diagnosis of pediatric cardiomyopathies. In this study, we compared and explored the correlation between these two measurements in pediatric patients with various cardiomyopathies.
A total of 53 pediatric patients with cardiomyopathy hospitalized during the recent 3 years in our hospital were analyzed. All of them and 22 normal controls were assessed by both cMRI and Echo. Cardiac function of the patients was graded according to the New York Heart Association functional classification. The cardiac function indexes measured with both cMRI and Echo included left-ventricular (LV) end-diastolic volume (EDV), end-systolic volume, ejection fraction and fractional shortening. These parameters were somehow lower in cMRI measurements than in Echo measurements. The index of diastolic function, such as peak filling rate (PFR) measured with cMRI, had a good correlation with the clinical cardiac functional score, while the index of the diastolic function (early/atrial filling ratio and isovolumic relaxation time) measured with Echo was not well correlated with the clinical cardiac function score. Significant systolic dysfunction was detected by cMRI in 34 patients with dilated cardiomyopathy, LV noncompaction or endocardial fibroelastosis. Significant diastolic dysfunction was detected by cMRI in 19 patients with hypertrophic cardiomyopathy or restrictive cardiomyopathy showing an alteration in PFR and EDV.
Both cMRI and Echo are of great value in the diagnosis and assessment of cardiac function in pediatric patients with cardiomyopathy. cMRI could accurately display the characteristic morphological changes in the hearts affected with cardiomyopathies, and late gadolinium enhancement on cMRI may reveal myocardial fibrosis, which has obvious advantages over Echo measurements in diagnosis. Furthermore, cMRI can quantitatively determine ventricular function because it does not make invalid geometrical assumptions.
心肌病是儿童常见的心血管疾病。心脏磁共振成像（cMRI）和超声心动图（Echo）常用于小儿心肌病的检测与诊断。本研究比较并探讨了这两种检测方法在不同类型小儿心肌病患者中的相关性。
分析了我院近3年收治的53例小儿心肌病患者。所有患者及22名正常对照均接受了cMRI和Echo检查。根据纽约心脏协会心功能分级对患者的心功能进行分级。通过cMRI和Echo测量的心脏功能指标包括左心室（LV）舒张末期容积（EDV）、收缩末期容积、射血分数和缩短分数。这些参数在cMRI测量中比在Echo测量中略低。cMRI测量的舒张功能指标，如峰值充盈率（PFR），与临床心功能评分具有良好的相关性，而Echo测量的舒张功能指标（早期/心房充盈率和等容舒张时间）与临床心功能评分相关性不佳。34例扩张型心肌病、左心室心肌致密化不全或心内膜弹力纤维增生症患者经cMRI检测出明显的收缩功能障碍。19例肥厚型心肌病或限制型心肌病患者经cMRI检测出明显的舒张功能障碍，表现为PFR和EDV改变。
cMRI和Echo在小儿心肌病患者的心功能诊断和评估中均具有重要价值。cMRI能够准确显示受心肌病影响心脏的特征性形态变化，cMRI上的延迟钆增强可能揭示心肌纤维化，这在诊断方面比Echo测量具有明显优势。此外，cMRI可以定量测定心室功能，因为它不做无效的几何假设。
