Yin Liang, Xu Hai-Yan, Zheng Sui-Sheng, Zhu Ying, Xiao Jiang-Xi, Zhou Wei, Yu Si-Si, Gong Liang-Geng
Department of Radiology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China.
Department of Radiology, Peking University First Hospital, Beijing, China.
Int J Cardiovasc Imaging. 2017 Dec;33(12):1949-1959. doi: 10.1007/s10554-017-1189-9. Epub 2017 Jun 13.
This study aimed to assess coronary microvascular dysfunction (CMD) differences in hypertrophic cardiomyopathy (HCM) patients using cardiac magnetic resonance (CMR) first-pass perfusion and late gadolinium enhancement imaging. Forty-seven patients with HCM and twenty-one healthy volunteers underwent CMR at rest. Imaging protocols included short axis cine, first-pass myocardial perfusion, and late gadolinium enhancement (LGE). Left ventricular end-diastolic wall thickness (EDTH), LGE, time to peak (T), maximal up-slope (Slope), and peak signal intensity (SI) were assessed for each myocardial segment. The HCM myocardial segments were grouped by the degree of LGE and hypertrophy. T, SI, Slope and EDTH in multiple groups were assessed and compared by ANOVA test/Kruskal-Wallis test. The Spearman correlation test was used to determine the relationships between EDTH, LGE and perfusion parameters (T, Slope and SI). Compared to control group segments, T increased while Slope and SI decreased in non-LGE/non-hypertrophic segments and LGE/hypertrophic segments in the HCM group, while T increased more significantly in LGE/hypertrophic segments (all p < 0.05). T statistically increased with increasing degrees of myocardial LGE (p < 0.01). Differences in T, SI and EDTH were observed between segments with and without hypertrophy (p < 0.05). EDTH and LGE were positively correlated with T (r = 0.279, p = 0.031 and r = 0.237, p < 0.001). 3.0 T magnetic resonance myocardial perfusion imaging identifies abnormal perfusion in non-LGE and non-hypertrophic segments of HCM patients, and it may be helpful in the early diagnosis of coronary microvascular dysfunction in HCM. This abnormal perfusion is associated with the severity of myocardial fibrosis and the degree of hypertrophy.
本研究旨在利用心脏磁共振成像（CMR）首过灌注和延迟钆增强成像评估肥厚型心肌病（HCM）患者的冠状动脉微血管功能障碍（CMD）差异。47例HCM患者和21名健康志愿者接受了静息状态下的CMR检查。成像方案包括短轴电影成像、首过心肌灌注和延迟钆增强（LGE）成像。对每个心肌节段评估左心室舒张末期壁厚度（EDTH）、LGE、达峰时间（T）、最大上升斜率（Slope）和峰值信号强度（SI）。将HCM心肌节段按LGE程度和肥厚程度分组。采用方差分析/克鲁斯卡尔-沃利斯检验评估和比较多组中的T、SI、Slope和EDTH。采用Spearman相关检验确定EDTH、LGE与灌注参数（T、Slope和SI）之间的关系。与对照组节段相比，HCM组非LGE/非肥厚节段和LGE/肥厚节段的T升高，而Slope和SI降低，而LGE/肥厚节段的T升高更显著（均p<0.05）。T随心肌LGE程度增加而有统计学意义地升高（p<0.01）。观察到有肥厚和无肥厚节段之间T、SI和EDTH存在差异（p<0.05）。EDTH和LGE与T呈正相关（r=0.279，p=0.031和r=0.237，p<0.001）。3.0 T磁共振心肌灌注成像可识别HCM患者非LGE和非肥厚节段的异常灌注，这可能有助于HCM患者冠状动脉微血管功能障碍的早期诊断。这种异常灌注与心肌纤维化的严重程度和肥厚程度相关。
