中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
10期
915-919
,共5页
朱孔博%程中伟%田庄%赵大春%刘永太%林雪%陈太波%谢洪智%曾勇%方理刚%姜秀春%崔全才%方全
硃孔博%程中偉%田莊%趙大春%劉永太%林雪%陳太波%謝洪智%曾勇%方理剛%薑秀春%崔全纔%方全
주공박%정중위%전장%조대춘%류영태%림설%진태파%사홍지%증용%방리강%강수춘%최전재%방전
心肌疾病%淀粉样变性%磁共振成像%活组织检查
心肌疾病%澱粉樣變性%磁共振成像%活組織檢查
심기질병%정분양변성%자공진성상%활조직검사
Cardiomyopathies%Amyloidosis%Magnetic resonance imaging%Biopsy
目的 研究心内膜心肌活检(EMB)确诊心肌淀粉样变性(CA)患者的临床和心脏核磁共振(CMR)特点,明确CMR在CA中的诊断价值.方法 回顾性分析2006年9月至2010年12月期间EMB确诊CA并行CMR检查患者的临床表现、心电图、心脏超声及CMR结果.结果 共18例患者通过EMB确诊为CA,其中5例进行了CMR检查.5例患者均有心力衰竭的临床表现以及心电图改变,心脏超声示左心室向心性肥厚,心肌回声增强、颗粒样回声,左心房扩大,限制性舒张功能不全.CMR主要表现为左心室壁增厚,室间隔增厚明显,双房均增大,心室收缩功能正常或减低,舒张功能均不同程度受限,部分伴有心包及胸腔积液,延迟钆显像(LGE)呈不同程度的延迟强化,位于左心室心内膜下或心肌弥漫性延迟强化,部分患者强化可为线样、颗粒样或斑片状.随病程延长,心肌LGE程度及范围有更严重的趋势,与心电图改变一致.结论 CMR有助于CA诊断及病情判断,为CA重要的无创检查方法之一.临床怀疑CA患者可早期进行CMR检查,特别是在没有开展EMB检查的医院.
目的 研究心內膜心肌活檢(EMB)確診心肌澱粉樣變性(CA)患者的臨床和心髒覈磁共振(CMR)特點,明確CMR在CA中的診斷價值.方法 迴顧性分析2006年9月至2010年12月期間EMB確診CA併行CMR檢查患者的臨床錶現、心電圖、心髒超聲及CMR結果.結果 共18例患者通過EMB確診為CA,其中5例進行瞭CMR檢查.5例患者均有心力衰竭的臨床錶現以及心電圖改變,心髒超聲示左心室嚮心性肥厚,心肌迴聲增彊、顆粒樣迴聲,左心房擴大,限製性舒張功能不全.CMR主要錶現為左心室壁增厚,室間隔增厚明顯,雙房均增大,心室收縮功能正常或減低,舒張功能均不同程度受限,部分伴有心包及胸腔積液,延遲釓顯像(LGE)呈不同程度的延遲彊化,位于左心室心內膜下或心肌瀰漫性延遲彊化,部分患者彊化可為線樣、顆粒樣或斑片狀.隨病程延長,心肌LGE程度及範圍有更嚴重的趨勢,與心電圖改變一緻.結論 CMR有助于CA診斷及病情判斷,為CA重要的無創檢查方法之一.臨床懷疑CA患者可早期進行CMR檢查,特彆是在沒有開展EMB檢查的醫院.
목적 연구심내막심기활검(EMB)학진심기정분양변성(CA)환자적림상화심장핵자공진(CMR)특점,명학CMR재CA중적진단개치.방법 회고성분석2006년9월지2010년12월기간EMB학진CA병행CMR검사환자적림상표현、심전도、심장초성급CMR결과.결과 공18례환자통과EMB학진위CA,기중5례진행료CMR검사.5례환자균유심력쇠갈적림상표현이급심전도개변,심장초성시좌심실향심성비후,심기회성증강、과립양회성,좌심방확대,한제성서장공능불전.CMR주요표현위좌심실벽증후,실간격증후명현,쌍방균증대,심실수축공능정상혹감저,서장공능균불동정도수한,부분반유심포급흉강적액,연지구현상(LGE)정불동정도적연지강화,위우좌심실심내막하혹심기미만성연지강화,부분환자강화가위선양、과립양혹반편상.수병정연장,심기LGE정도급범위유경엄중적추세,여심전도개변일치.결론 CMR유조우CA진단급병정판단,위CA중요적무창검사방법지일.림상부의CA환자가조기진행CMR검사,특별시재몰유개전EMB검사적의원.
Objective To observe the clinical features and cardiac magnetic resonance imaging (CMR) characteristics of patients with endomyocardial biopsy (EMB)-proven cardiac amyloidosis (CA).Methods EMB proven CA patients underwent CMR examination from September 2006 to December 2010 were included.The findings of clinical manifestation,electrocardiogram,echocardiography and CMR were analyzed.Results Among the 18 patients with EMB verified CA,5 patients underwent CMR.All 5 patients had heart failure symptoms and electrocardiogram was abnormal.Echocardiogram showed concentric left ventricular hypertrophy,granular appearance of the myocardium,left atrial enlargement and moderate to severe left ventricular diastolic dysfunction.CMR revealed increased thickness of the left ventricular wall (especially at the inter-ventricular septum),enlarged bilateral auricle,restricted left ventricular filling with normal or mild to moderate reduced systolic function.Pleural and pericardial effusions were observed in 2 patients.Abnormal late gadolinium enhancement (LGE) was detected in all 5 patients.CMR revealed different patterns of LGE.Left ventricular global subendocardial delayed gadolinium enhancement or transmural delayed gadolinium enhancement were found,and patients also showed line-,granular- or patchylike enhancement.The degree and range of LGE paralleled the disease course and were consistent with electrocardiogram changes.Conclusions As a noninvasive diagnostic tool,CMR is valuable in the diagnosis of CA.For patients with clinical suspicion of CA,CMR could be a helpful diagnostic tool,especially in the hospitals where EMB is not available.
