高血压性心脏病与肥厚型心肌病：舒张末期室壁厚度≥15mm时的多参数心血管磁共振鉴别指标
Hypertensive heart disease versus hypertrophic cardiomyopathy: multi-parametric cardiovascular magnetic resonance discriminators when end-diastolic wall thickness ≥ 15 mm.
作者信息
Rodrigues Jonathan C L, Rohan Stephen, Ghosh Dastidar Amardeep, Harries Iwan, Lawton Christopher B, Ratcliffe Laura E, Burchell Amy E, Hart Emma C, Hamilton Mark C K, Paton Julian F R, Nightingale Angus K, Manghat Nathan E
机构信息
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, University Walk, Bristol, BS8 1TD, UK.
出版信息
Eur Radiol. 2017 Mar;27(3):1125-1135. doi: 10.1007/s00330-016-4468-2. Epub 2016 Jul 1.
OBJECTIVES
European guidelines state left ventricular (LV) end-diastolic wall thickness (EDWT) ≥15mm suggests hypertrophic cardiomyopathy (HCM), but distinguishing from hypertensive heart disease (HHD) is challenging. We identify cardiovascular magnetic resonance (CMR) predictors of HHD over HCM when EDWT ≥15mm.
METHODS
2481 consecutive clinical CMRs between 2014 and 2015 were reviewed. 464 segments from 29 HCM subjects with EDWT ≥15mm but without other cardiac abnormality, hypertension or renal impairment were analyzed. 432 segments from 27 HHD subjects with EDWT ≥15mm but without concomitant cardiac pathology were analyzed. Magnitude and location of maximal EDWT, presence of late gadolinium enhancement (LGE), LV asymmetry (>1.5-fold opposing segment) and systolic anterior motion of the mitral valve (SAM) were measured. Multivariate logistic regression was performed. Significance was defined as p<0.05.
RESULTS
HHD and HCM cohorts were age-/gender-matched. HHD had significantly increased indexed LV mass (110±27g/m vs. 91±31g/m, p=0.016) but no difference in site or magnitude of maximal EDWT. Mid-wall LGE was significantly more prevalent in HCM. Elevated indexed LVM, mid-wall LGE and absence of SAM were significant multivariate predictors of HHD, but LV asymmetry was not.
CONCLUSIONS
Increased indexed LV mass, absence of mid-wall LGE and absence of SAM are better CMR discriminators of HHD from HCM than EDWT ≥15mm.
KEY POINTS
• Hypertrophic cardiomyopathy (HCM) is often diagnosed with end-diastolic wall thickness ≥15mm. • Hypertensive heart disease (HHD) can be difficult to distinguish from HCM. • Retrospective case-control study showed that location and magnitude of EDWT are poor discriminators. • Increased left ventricular mass and midwall fibrosis are independent predictors of HHD. • Cardiovascular magnetic resonance parameters facilitate a better discrimination between HHD and HCM.
目的
欧洲指南指出，左心室舒张末期壁厚（EDWT）≥15mm提示肥厚型心肌病（HCM），但与高血压性心脏病（HHD）进行鉴别具有挑战性。我们确定当EDWT≥15mm时，HHD相对于HCM的心血管磁共振（CMR）预测指标。
方法
回顾了2014年至2015年间连续的2481例临床CMR检查。分析了29例EDWT≥15mm但无其他心脏异常、高血压或肾功能损害的HCM患者的464个节段。分析了27例EDWT≥15mm但无合并心脏病变的HHD患者的432个节段。测量最大EDWT的大小和位置、延迟钆增强（LGE）的存在、左心室不对称性（>1.5倍对侧节段）以及二尖瓣收缩期前向运动（SAM）。进行多变量逻辑回归分析。显著性定义为p<0.05。
结果
HHD组和HCM组在年龄和性别上相匹配。HHD组的左心室质量指数显著增加（110±27g/m²对91±31g/m²，p=0.016），但最大EDWT的部位或大小无差异。中壁LGE在HCM中更为常见。左心室质量指数升高、中壁LGE和无SAM是HHD的显著多变量预测指标，但左心室不对称性不是。
结论
与EDWT≥15mm相比，左心室质量指数增加、无中壁LGE和无SAM是CMR鉴别HHD与HCM的更好指标。
关键点
•肥厚型心肌病（HCM）常根据舒张末期壁厚≥15mm进行诊断。•高血压性心脏病（HHD）可能难以与HCM区分。•回顾性病例对照研究表明，EDWT的部位和大小是较差的鉴别指标。•左心室质量增加和中壁纤维化是HHD的独立预测指标。•心血管磁共振参数有助于更好地鉴别HHD和HCM。
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