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  • 王铮,马晓海*,赵蕾,陆艾嘉,田洁,范占明,徐磊.肥厚型心肌病和扩张型心肌病合并冠状动脉粥样硬化性心脏病心脏[J].第二军医大学学报,2019,40(3):270-276    [点击复制]
  • WANG Zheng,MA Xiao-hai*,ZHAO Lei,LU Ai-jia,TIAN Jie,FAN Zhan-ming,XU Lei.Cardiac magnetic resonance imaging features of hypertrophic cardiomyopathy and dilated cardiomyopathy combined with coronary atherosclerotic heart disease[J].Acad J Sec Mil Med Univ,2019,40(3):270-276   [点击复制]
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肥厚型心肌病和扩张型心肌病合并冠状动脉粥样硬化性心脏病心脏
王铮,马晓海*,赵蕾,陆艾嘉,田洁,范占明,徐磊
0
(首都医科大学附属北京安贞医院医学影像科, 北京 100029
*通信作者)
摘要:
目的基于心脏磁共振成像探讨原发性肥厚型心肌病(HCM)和扩张型心肌病(DCM)患者冠状动脉粥样硬化性心脏病(以下简称“冠心病”)的发生率及影像学特征。方法回顾性分析我院2015年9月至2018年9月经心脏磁共振检查确诊为HCM或DCM且同期完成冠状动脉检查(冠状动脉造影或冠状动脉计算机断层扫描)的患者的临床及影像学资料。两种类型心肌病患者均依据血管狭窄程度分为冠状动脉正常组、冠状动脉粥样硬化组(管腔狭窄≤50%)及冠心病组(管腔狭窄>50%),比较两种类型心肌病患者冠状动脉疾病的发生情况,以及两种类型心肌病患者3组间临床及磁共振影像学特征的差异。结果心脏磁共振检查符合各类型原发性心肌病患者共681例,其中219例同时进行了冠状动脉相关检查,包括HCM 126例、DCM 78例、其他类型心肌病15例。HCM患者冠状动脉粥样硬化和冠心病的发生率分别为31.7%(40/126)、21.4%(27/126),与DCM患者[分别为30.8%(24/78)、17.9%(14/78)]相比差异均无统计学意义(P均>0.05)。HCM与DCM冠心病组患者的平均年龄分别为(62.6±9.8)岁、(60.1±7.2)岁,冠状动脉粥样硬化组分别为(59.3±9.5)岁、(58.5±8.8)岁,均分别高于冠状动脉正常组的(49.5±11.0)岁、(49.3±12.9)岁,差异均有统计学意义(P均<0.05)。存在心血管危险因素(糖尿病、吸烟、高血压、高脂血症或肥胖)的HCM和DCM患者的冠心病发生率均较高,分别为70.4%(19/27)、71.4%(10/14)。心脏磁共振成像检查示,除HCM患者冠心病组左心室每搏输出量低于冠状动脉正常组及冠状动脉粥样硬化组[(50.4±21.1)mL vs(64.6±22.9)mL、(64.1±27.1)mL,P均<0.05]外,其他指标如左心室舒张末期内径、心肌内纤维化检出率及左心室功能参数在HCM和DCM患者3组之间差异均无统计学意义(P均>0.05)。结论 HCM和DCM患者均可合并冠状动脉疾病,心脏磁共振检查可以用于诊断心肌病,特别是对合并冠心病心肌梗死的鉴别诊断。
关键词:  肥厚型心肌病  扩张型心肌病  冠心病  磁共振成像
DOI:10.16781/j.0258-879x.2019.03.0270
投稿时间:2018-10-29修订日期:2019-01-15
基金项目:国家自然科学基金(81671647,81771787),北京市自然科学基金(7172069).
Cardiac magnetic resonance imaging features of hypertrophic cardiomyopathy and dilated cardiomyopathy combined with coronary atherosclerotic heart disease
WANG Zheng,MA Xiao-hai*,ZHAO Lei,LU Ai-jia,TIAN Jie,FAN Zhan-ming,XU Lei
(Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
*Corresponding author)
Abstract:
Objective To investigate the incidence and cardiac magnetic resonance imaging features of coronary atherosclerotic artery disease (CAD) in the patients with hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM). Methods A retrospective study was conducted on the clinical and imaging data of the patients who had HCM or DCM diagnosed by cardiac magnetic resonance examination and received coronary examination (coronary angiography or computed tomography) from Sep. 2015 to Sep. 2018. According to the severity of coronary stenosis, the patients with HCM or DCM were divided into normal coronary group, coronary atherosclerosis group (lumen stenosis ≤ 50%) and CAD group (lumen stenosis>50%). The incidence of coronary diseases and the clinical and magnetic resonance imaging features were compared among the three groups. Results A total of 681 patients with primary cardiomyopathy were examined by cardiac magnetic resonance. Two hundred and nineteen of them underwent coronary angiography or computed tomography, including 126 cases with HCM, 78 cases with DCM and 15 cases of other types with cardiomyopathy. The incidence of coronary atherosclerosis and CAD in the HCM patients was 31.7% (40/126) and 21.4% (27/126), respectively, which was not significantly different from that in the DCM patients (30.8%[24/78] and 17.9%[14/78], respectively; both P>0.05). In the patients with HCM and DCM, the mean ages of the CAD group and coronary atherosclerosis group were (62.6±9.8) and (60.1±7.2) years, and (59.3±9.5) and (58.5±8.8) years, respectively, which were higher than those of the normal coronary group ([49.5±11.0] and[49.3±12.9] years, respectively), and the differences were significant (all P<0.05). Both HCM and DCM patients with cardiovascular risk factors (diabetes, smoking, hypertension, hyperlipidemia or obesity) had high incidence of CAD (70.4%[19/27] and 71.4%[10/14], respectively). The left ventricular stroke volume of the CAD group in the HCM patients was significantly lower than those of the normal coronary and coronary atherosclerosis groups ([50.4±21.1] mL vs[64.6±22.9] mL and[64.1±27.1] mL, both P<0.05). There were no significant differences in the left ventricular end-diastolic diameter, detection rate of intramyocardial fibrosis or other left ventricular function parameters among the three groups both in the HCM and DCM patients (all P>0.05). Conclusion Both HCM and DCM patients can be complicated with CAD. Cardiac magnetic resonance imaging can be used to diagnose cardiomyopathy, especially in the differential diagnosis of CAD with myocardial infarction.
Key words:  hypertrophic cardiomyopathy  dilated cardiomyopathy  coronary heart disease  magnetic resonance imaging