Lee Hye-Jeong, Uhm Jae-Sun, Joung Boyoung, Hong Yoo Jin, Hur Jin, Choi Byoung Wook, Kim Young Jin
1 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
2 Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
AJR Am J Roentgenol. 2016 Apr;206(4):719-25. doi: 10.2214/AJR.15.15141. Epub 2016 Feb 11.
Myocardial dyskinesia caused by the accessory pathway and related reversible heart failure have been well documented in echocardiographic studies of pediatric patients with Wolff-Parkinson-White (WPW) syndrome. However, the long-term effects of dyskinesia on the myocardium of adult patients have not been studied in depth. The goal of the present study was to evaluate regional myocardial abnormalities on cardiac CT examinations of adult patients with WPW syndrome.
Of 74 patients with WPW syndrome who underwent cardiac CT from January 2006 through December 2013, 58 patients (mean [± SD] age, 52.2 ± 12.7 years), 36 (62.1%) of whom were men, were included in the study after the presence of combined cardiac disease was excluded. Two observers blindly evaluated myocardial thickness and attenuation on cardiac CT scans. On the basis of CT findings, patients were classified as having either normal or abnormal findings. We compared the two groups for other clinical findings, including observations from ECG, echocardiography, and electrophysiologic study.
Of the 58 patients studied, 16 patients (27.6%) were found to have myocardial abnormalities (i.e., abnormal wall thinning with or without low attenuation). All abnormal findings corresponded with the location of the accessory pathway. Patients with abnormal findings had statistically significantly decreased left ventricular function, compared with patients with normal findings (p < 0.001). The frequency of regional wall motion abnormality was statistically significantly higher in patients with abnormal findings (p = 0.043). However, echocardiography documented structurally normal hearts in all patients.
A relatively high frequency (27.6%) of regional myocardial abnormalities was observed on the cardiac CT examinations of adult patients with WPW syndrome. These abnormal findings might reflect the long-term effects of dyskinesia, suggesting irreversible myocardial injury that ultimately causes left ventricular dysfunction.
在小儿预激综合征（WPW）患者的超声心动图研究中，已充分记录了由旁路引起的心肌运动障碍及相关可逆性心力衰竭。然而，运动障碍对成年患者心肌的长期影响尚未得到深入研究。本研究的目的是评估成年WPW综合征患者心脏CT检查中的局部心肌异常情况。
2006年1月至2013年12月期间接受心脏CT检查的74例WPW综合征患者中，排除合并心脏病后，纳入58例患者（平均年龄[±标准差]为52.2±12.7岁），其中36例（62.1%）为男性。两名观察者对心脏CT扫描图像进行盲法评估，测量心肌厚度并观察衰减情况。根据CT检查结果，将患者分为正常组和异常组。比较两组患者的其他临床检查结果，包括心电图、超声心动图和电生理检查结果。
在58例研究患者中，16例（27.6%）被发现存在心肌异常（即伴有或不伴有低衰减的异常室壁变薄）。所有异常表现均与旁路位置相对应。与正常表现的患者相比，异常表现的患者左心室功能在统计学上显著降低（p<0.001）。异常表现的患者区域室壁运动异常的发生率在统计学上显著更高（p=0.043）。然而，超声心动图显示所有患者心脏结构正常。
在成年WPW综合征患者的心脏CT检查中，观察到相对较高频率（27.6%）的局部心肌异常。这些异常表现可能反映了运动障碍的长期影响，提示存在不可逆的心肌损伤，最终导致左心室功能障碍。
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