肥厚型心肌病磁共振钆剂延迟增强与心电图 QTe/RR的关系

摘要：目的 探讨肥厚型心肌病（HCM）磁共振钆剂延迟增强与动态心电图QTe/RR斜率的关系。方法 将本院 2016 年 1 月—2017 年 6 月接诊的 96 例 HCM 患者，根据心脏磁共振扫描（CMR）是否出现钆剂延迟增强（LGE）分为 LGE阳性组和LGE阴性组。采用评分法评估LGE阳性组患者LGE透壁程度。所有受试者行24 h动态心电图检查， 计算心率（HR）、QT间期及QTe/RR斜率。分析LGE阳性组总LGE评分与QTe/RR斜率之间的相关性，分析LGE透壁 程度和QTe/RR斜率与患者预后的关系。结果 CMR结果显示LGE阳性51例（53.13%），LGE阴性45例（46.87%）； LGE阳性组与LGE阴性组左心室射血分数（LVEF：0.412±0.092 vs. 0.508±0.083）、左心室舒张末期容积［LVEDV（mL）： 173.91±43.68 vs.148.52±31.77］及左心室舒张末期后壁厚度［LVPWD（mm）：13.26±2.81 vs. 12.15±2.37］比较差异有统 计学意义（t分别为5.301、3.219、2.077，均P＜0.05）；LGE阳性组QT间期（ms：439.67±25.82 vs. 411.53±31.66）、QTe/RR 斜率（0.20±0.05 vs. 0.16±0.03）均高于 LGE 阴性组（t 分别为 4.794、4.674，均 P＜0.05）；LGE 阳性组总 LGE 评分为 （26.37±7.52）分，与QTe/RR斜率呈正相关（r=0.742，P＜0.001）；LGE阳性组室性心律失常、心源性猝死等不良反应发 生率高于LGE阴性组（17.65% vs. 4.44%，c2=4.107，P＜0.05）；总LGE评分、QTe/RR斜率与患者室性心律失常、心源性 猝死有关（P＜0.05）。结论 HCM患者LGE程度与QTe/RR斜率显著相关，综合评估两项指标可能更有助于HCM预 后判断

The relationship between late gadolinium enhancement in magnetic resonance and electrocardiogram QTe/RR in hypertrophic cardiomyopathy

Abstract: Objective To investigate the relationship between late gadolinium enhancement (LGE) in magnetic resonance and the slope of dynamic electrocardiogram QTe / RR in hypertrophic cardiomyopathy (HCM). Methods According to the presence of LGE in cardiac magnetic resonance imaging (CMR), 96 patients with HCM who were admitted to our hospital from January 2016 to June 2017 were divided into LGE positive group and LGE negative group. The LGE transmurality of LGE positive group was evaluated by scoring method. All subjects underwent 24 h dynamic echocardiography, and heart rate (HR), QT interval and QTe/RR slope were calculated. The correlation between total LGE score and the slope of QTe/RR in LGE positive group was analyzed. And the relationships between the transmural degree of LGE and the slope of QTe/RR with the prognosis of patients were also analyzed. Results CMR results showed that there were 51 cases of positive LGE (53.13%), 45 cases of negative LGE (46.87%). There were significant differences in left ventricular ejection fraction (LVEF: 0.412 ± 0.092 vs. 0.508 ± 0.083), left ventricular end-diastolic volume LVEDV (mL): 173.91±43.68 vs. 148.52±31.77] and left ventricular end-diastolic wall thickness LVPWD (mm): 13.26±2.81 vs. 12.15± 2.37] between LGE positive group and LGE negative group (t=5.301, 3.219 and 2.077, P＜0.05). The QT interval (439.67± 25.82 vs. 411.53±31.66) and QTe/RR slope (0.20±0.05 vs. 0.16±0.03) were significantly longer in LGE positive group than those of LGE negative group (t=4.794 and 4.674, P＜0.05). The total LGE score was 26.37 ± 7.52, which was positively correlated with the slope of QTe/RR in LGE positive group (r=0.742, P＜0.001). The incidence of adverse reactions such as ventricular arrhythmia and sudden cardiac death were significantly higher in LGE positive group than those in LGE negative group (c2=4.107, P＜0.05). The total LGE score and QTe / RR slope were related to ventricular arrhythmia and sudden cardiac death (P＜0.05). Conclusion The LGE degree of HCM patients is significantly correlated with the slope of QTe/ RR. The comprehensive evaluation of the two indicators may be more helpful to predict the prognosis of HCM.