CAJ | 학술논문

目的探讨肥厚型心肌病延迟增强磁共振成像(MRI)显示的心肌纤维化与心律失常的相关性.方法对48例未经治疗的肥厚型心肌病患者进行了MRI心功能分析、钆喷替酸葡甲胺(Gd-DTPA)延迟增强MRI、常规心电图和24 b动态心电图检查.分别探讨延迟增强MRI与频发室性期前收缩(PVCS总数≥200个)、阵发性室上性心动过速(SVT)、非持续性室性心动速(NSVT)、房室传导阻滞(AVB)、室内传导阻滞(IVB)之间的关系.计算延迟强化心肌质量、延迟强化心肌质量百分比,并分析其与24 h内PVCS、SVT和NSVT总数,传导阻滞(PR间期、QRS时限)间的相关性.描述肥厚型心肌病延迟强化节段的分布和特征.结果 48例肥厚型心肌病患者中35例出现延迟强化.出现PVCS、SVT、NSVT、AVB、IVB等心律失常的肥厚型心肌病患者中,延迟增强阳性患者出现PVCS、SVT、NSVT的数目显著大于延迟增强阴性患者(P=0.001～0.03).延迟强化心肌质量百分比与QRS时限呈正相关(r=0.33,P＜0.001).结论延迟增强MRI显示的心肌纤维化与心律失常相关,可能为存在(或潜在)并发心律失常的肥厚型心肌病患者提供更多评估病情和预后的信息.
목적 탐토비후형심기병연지증강자공진성상(MRI)현시적심기섬유화여심률실상적상관성.방법 대48례미경치료적비후형심기병환자진행료MRI심공능분석、구분체산포갑알(Gd-DTPA)연지증강MRI、상규심전도화24 b동태심전도검사.분별탐토연지증강MRI여빈발실성기전수축(PVCS총수≥200개)、진발성실상성심동과속(SVT)、비지속성실성심동속(NSVT)、방실전도조체(AVB)、실내전도조체(IVB)지간적관계.계산연지강화심기질량、연지강화심기질량백분비,병분석기여24 h내PVCS、SVT화NSVT총수,전도조체(PR간기、QRS시한)간적상관성.묘술비후형심기병연지강화절단적분포화특정.결과 48례비후형심기병환자중35례출현연지강화.출현PVCS、SVT、NSVT、AVB、IVB등심률실상적비후형심기병환자중,연지증강양성환자출현PVCS、SVT、NSVT적수목현저대우연지증강음성환자(P=0.001～0.03).연지강화심기질량백분비여QRS시한정정상관(r=0.33,P＜0.001).결론 연지증강MRI현시적심기섬유화여심률실상상관,가능위존재(혹잠재)병발심률실상적비후형심기병환자제공경다평고병정화예후적신식.
Objective To observe the association between myocardial fibrosis,detected by delayed-enhancement(DE) cardiac magnetic resonance imaging (MRI) and arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Methods Forty-eight untreated HCM patients who underwent Cine MR, DE-MRI,24 h ambulatory Holter electrocardiogram and ECG examinations were recruited. Extent of myocardial fibrosis (fibrosis mass/total LV mass) was assessed using DE imaging. Association between arrhythmias including premature ventricular complexes ( PVCS ≥ 200 ), supra-ventricular tachycardia ( SVT ), non-sustained ventricular tachycardia (NSVT), atrio-ventricular block (AVB) and intra-ventricular block (IVB) detected by Holter monitoring and ECG with regard to delayed enhancement (DE) on contrast enhanced CMR was analyzed. Results Myocardial fibrosis was detected in 35 patients. Incidence of arrhythmia was significantly higher in patients with DE than in patients without DE ( P ＜ 0. 05 ). Extent of myocardial fibrosis was significantly associated with the QRS duration ( r = 0. 33, P ＜ 0. 001 ). Conclusion Myocardial fibrosis detected by DE-CMR was associated with arrhythmia in patients with HCM. DE-CMR might be helpful to detect high-risk HCM patients prone to arrhythmia.