Yao Lu, Ta Shengjun, Wang Jing, Han Chao, Lei Changhui, Li Wenxia, Li Jing, Wang Bo, Zhao Xueli, Liu Liwen
Department of Ultrasound, Xijing Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Military Medical University, 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
Int J Cardiovasc Imaging. 2024 Jul;40(7):1483-1492. doi: 10.1007/s10554-024-03126-7. Epub 2024 May 6.
The data on myocardial perfusion of the percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for obstructive hypertrophic cardiomyopathy (HOCM) are still lacking, although PIMSRA have been proved to be of great safety and efficacy. The aim of this study was to quantitatively analyze the changes in myocardial perfusion after PIMSRA using myocardial contrast echocardiography (MCE). 27 HOCM patients treated with PIMSRA were retrospectively analyzed, and their echocardiographic parameters and perfusion parameters of MCE were collected before and 12 months after PIMSRA. A reperfusion curve was used to quantify microvascular blood volume (A), microvascular flux rate (β), and microvascular blood flow (MBF) of each segment. Then the value difference (Δ) of parameters between post- and pre-operation were calculated. Finally, the correlation between the changes in MBF and in each echocardiographic parameter was analyzed. (1) Compared with baseline, the global A, β and MBF were significantly increased in HOCM patients after PIMSRA (all P < 0.001). The β, MBF were increased in the interventricular septum (P < 0.001, respectively), and the A, β, MBF were increased in the left ventricular wall (all P < 0.001). (2) Correlation analysis showed that the ΔMBF of interventricular septum was mainly negatively correlated with the maximum interventricular septum thickness (ΔIVSTmax, r=-0.670, P < 0.001), mean interventricular septum thickness (ΔIVSTmean, r=-0.690, P < 0.001), and left ventricular mass index (ΔLVMI, r=-0.774, P < 0.001), while the ΔMBF of left ventricular wall was positively correlated with left ventricular end-diastolic volume index (ΔLVEDVI, r = 0.621, P = 0.001) and stroke volume index (ΔSVI, r = 0.810, P < 0.001). Myocardial perfusion was improved at both interventricular septum and ventricular wall in HOCM patients after PIMSRA. MCE can provide a new dimension for the efficacy evaluation to PIMSRA procedure.
尽管经皮心肌间隔射频消融术（PIMSRA）已被证明具有很高的安全性和有效性，但关于其治疗梗阻性肥厚型心肌病（HOCM）的心肌灌注数据仍然缺乏。本研究的目的是使用心肌对比超声心动图（MCE）定量分析PIMSRA术后心肌灌注的变化。回顾性分析27例接受PIMSRA治疗的HOCM患者，收集其PIMSRA术前和术后12个月的超声心动图参数及MCE灌注参数。采用再灌注曲线定量分析各节段的微血管血容量（A）、微血管流速（β）和微血管血流量（MBF）。然后计算术后与术前参数的差值（Δ）。最后，分析MBF变化与各超声心动图参数变化之间的相关性。（1）与基线相比，PIMSRA术后HOCM患者的整体A、β和MBF均显著增加（均P < 0.001）。室间隔的β、MBF增加（分别为P < 0.001），左心室壁的A、β、MBF增加（均P < 0.001）。（2）相关性分析显示，室间隔的ΔMBF主要与室间隔最大厚度（ΔIVSTmax，r=-0.670，P < 0.001）、室间隔平均厚度（ΔIVSTmean，r=-0.690，P < 0.001）和左心室质量指数（ΔLVMI，r=-0.774，P < 0.001）呈负相关，而左心室壁的ΔMBF与左心室舒张末期容积指数（ΔLVEDVI，r = 0.621，P = 0.001）和每搏输出量指数（ΔSVI，r = 0.810，P < 0.001）呈正相关。PIMSRA术后HOCM患者的室间隔和心室壁心肌灌注均得到改善。MCE可为PIMSRA手术的疗效评估提供一个新的维度。
