Application of gadolinium delayed enhancement combined with cardiac magnetic resonance T1 mapping in cardic amyloidosis and hypertrophic cardiomyopathy: prospective study of 95 patients
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摘要:
目的 研究钆延迟强化联合心脏磁共振T1 mapping在心肌淀粉样变性（CA）和肥厚性心肌病（HCM）患者临床检查中的应用。 方法 采用前瞻性研究方法，以我院2018年12月~2020年12月诊断的CA患者40例和HCM患者55例作为研究对象，另选取同期进行健康体检的患者54例作为对照组，比较3组患者的心功能、心脏形态学、MRI相关指标之间的差异。 结果 左心室收缩期末容积、左心室射血分数在3组间的差异存在统计学意义（P < 0.05），通过两两比较，左心室收缩期末容积、左心室射血分数从高到低依次为HCM组、对照组、CA组，3组患者的LVEF差异不存在统计学意义（P > 0.05）；左室壁厚度以及左心室质量从高到低依次为HCM组、CA组以及对照组（P < 0.05）；增强前T1值从高到低依次为CA组、HCM组以及对照组（P < 0.05）；增强后T1值从高到低依次为HCM组、对照组以及CA组（P < 0.05）；细胞外容积从高到低依次为CA组、对照组以及HCM组（P < 0.05）。 结论 钆延迟强化联合心脏磁共振T1 mapping在CA和HCM患者临床检查中具有较好的鉴别诊断能力，建议临床推广。 -
关键词:
- 钆延迟强化 /
- 心脏磁共振 /
- T1 mapping /
- 联合检测
Abstract:Objective To explore the application of gadolinium delayed enhancement combined with cardiac magnetic resonance T1 mapping in the clinical examination of patients with cardic amyloidosis (CA) and hypertrophic cardiomyopathy (HCM). Methods In this prospective study, 40 CA patients and 55 HCM patients diagnosed in our hospital from December 2018 to December 2020 were selected as the research objects, and 54 healthy patients were selected as the control group. The cardiac function, cardiac morphology, and MRI related indicators in three groups were compared. Results The difference between the levels of LVESV and LVEDV of three groups was significant (P < 0.05). By pairwise comparison, the levels of LVESV and LVEDV were the HCM group, the control group and the CA group in descending order. There was no significant difference in LVEF between the three groups of patients (P > 0.05). The left ventricular wall thickness and left ventricular mass of the three groups were the HCM group, the CA group and the control group in descending order (P < 0.05). The T1 values of the three groups were the CA Group, the HCM group and the control group in descending order (P < 0.05). After the enhancement, the T1 value was the HCM group, the control group and the CA group in descending order. The extracellular volume was the CA group, the control group and the HCM group in descending order (P < 0.05). Conclusion Gadolinium delayed enhancement combined with cardiac magnetic resonance T1 mapping has a good differential diagnosis ability in the clinical examination of CA and HCM patients. -
图 1 心肌淀粉样变性和肥厚性心肌病图
A：心肌淀粉样变性，T1 mapping示左室心肌T1值增高; B: 心肌淀粉样变性，心肌延迟增强显示室间隔及左室壁各节段心肌弥漫性延迟强化; C: 肥厚性心肌病，左室间壁，部分前壁，部分下壁对比剂廓清延迟，可见弥漫性斑片状高信号; D：肥厚性心肌病，心肌延迟增强显示左室间壁，部分前壁，部分下壁对比剂廓清延迟，可见弥漫性斑片状高信号.
Figure 1. Myocardial amyloidosis and hypertrophic cardiomyopathy.
表 1 一般资料比较
Table 1. Comparison of general information
项目 性別(男/女，n) 年龄（岁，Mean±SD) BMI(kg/m2, Mean±SD） CA组(n=40) 16/24 46.29±2.05 24.55±3.43 HCM组（n=55) 22/33 46.55±2.42 24.30±3.09 对照组(n=54) 21/33 46.41±2.79 24.69±3.44 F/χ2 1.427 0.898 0.593 P 0.426 0.370 0.554 CA: 心肌淀粉样变性; HCM: 肥厚性心肌病. 
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表 2 心功能比较
Table 2. Comparison of cardiac function (Mean±SD)
项目 LVESV(mL/m2) LVEDV(mL/m2) LVEF(%) CA组(n=40) 49.74±11.37 85.21±21.95 56.33±11.33 HCM组（n=55) 69.70±11.51 141.60±21.96 51.37±11.57 对照组(n=54) 50.65±11.45 119.21±21.77 53.10±11.77 F 11.236 10.239 0.698 P < 0.001 < 0.001 0.336 LSD-t(CA vs HCM) 10.336 9.887 - P < 0.001 < 0.001 - LSD-t(CA vs对照) 9.584 9.996 - P < 0.001 < 0.001 - LSD-t(对照vs HCM) 8.256 7.559 - P < 0.001 < 0.001 -
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表 3 三组研究对象的心脏形态学指标比较
Table 3. Comparison of cardiac morphological indexes among three groups (Mean±SD)
项目 左室壁厚度(mm) 左心室质量(g) CA组(n=40) 13.96±2.63 160.52±2.14 HCM组(n=55) 16.99±1.96 211.03±12.14 对照组(n=54) 6.91±2.47 105.32±1.45 F 11.230 12.698 P < 0.001 < 0.001 LSD-t(CA vs HCM) 9.885 9.647 P < 0.001 < 0.001 LSD-t(CA vs对照) 8.552 8.698 P < 0.001 < 0.001 LSD-t(对照vs HCM) 7.885 6.997 P < 0.001 < 0.001
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表 4 核磁共振的相关指标比较
Table 4. Comparison of MRI related indexes(Mean±SD)
项目 增强前T1值 增强后T1值 细胞外容积(%) CA组(n=40) 1481.77±87.24 455.27±3.31 48.04±4.24 HCM组（n=55) 1381.27±66.94 578.77±3.27 26.88±4.17 对照组(n=54) 1273.77±77.24 521.27±3.31 27.04±4.24 F 12.369 15.698 15.741 P < 0.001 < 0.001 < 0.001 LSD-t(CA vs HCM) 10.258 10.697 11.587 P < 0.001 < 0.001 < 0.001 LSD-t(CA vs对照） 9.885 10.587 10.555 P < 0.001 < 0.001 < 0.001 LSD-t(对照vs HCM) 9.885 10.202 10.636 P < 0.001 < 0.001 < 0.001
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