成人先天性心脏病合并肺动脉高压患者的心脏磁共振评估

目的 探讨心脏磁共振（cardiac magnetic resonance,CMR）评价先天性心脏病合并肺动脉高压患者心室功能的临床价值.方法 对26例先天性心脏病合并肺动脉高压的患者行CMR检查,分别测量并计算右心室与左心室的短轴缩短率、舒张末期直径、舒张末期容积、收缩末期容积、每搏排血量、射血分数等心功能参数及主动脉、肺动脉直径,同时评价室间隔运动、心肌延时强化.采用配对样本t检验比较左、右心室功能参数,采用两个独立样本t检验比较室间隔运动正常组和异常组的右心功能情况,采用卡方检验比较室间隔运动异常与心肌延时强化的关联.结果 右心室舒张末期直径、舒张末期容积、收缩末期容积均显著高于左心室,差异有统计学意义（P＜0.05）;右心室短轴缩短率、射血分数均显著低于左心室,差异有统计学意义（P＜0.05）.26例患者中,14例室间隔运动异常,14例出现心肌延时强化.室间隔运动异常组心肌延时强化出现比例明显高于室间隔运动正常组,差异有统计学意义（P＜0.05）.同时,室间隔运动异常组的右心室舒张末期直径、舒张末期容积均显著高于正常组,差异有统计学意义（P＜0.05）;右心室短轴缩短率显著低于正常组,差异有统计学意义（P＜0.05）;射血分数低于正常组,但差异无统计学意义（P=0.08）.结论 合并肺动脉高压的成人先天性心脏病患者右心功能较左心功能差,室间隔运动异常患者的右心功能更差,室间隔运动异常患者出现心肌延时强化比例高.CMR能够提供先天性心脏病合并肺动脉高压患者的左、右心室功能及相关结构信息,对治疗和预后有重要价值.

Assessment of cardiac magnetic resonance imaging in adult patients with congenital heart disease complicated with pulmonary artery hypertension

Objectives To explore the clinical application value of cardiac magnetic resonance （CMR） imaging in assessment of ventricular function in patients with congenital heart disease （CHD） complicated with pulmonary artery hypertension （PAH）.Methods Totally 26 adult patients with CHD complicated with PAH had undergone CMR exam.The left and right ventricular function were measured on images of cine series including end-diastolic diameter （EDD）,end-diastolic volume （EDV）,end-systolic volume （ESV）,stroke volume （SV）,shortening fraction （SF）,ejection fraction （EF）and motion of interventricular septum （IS）.Myocardium enhancement was evaluated on images of delayed enhancement series.Bilateral ventricular functions of total 26 patents were compared using paired t test.Right ventricular functions were compared using two independent-samples t test and numbers of myocardium abnormal delayed enhancement were compared using x2 test between normal group and abnormal group in motion of IS.Results Compared with left ventricle,the values of EDD,EDV and ESV of right ventricle were significant higher and the values of SF and EF were significant lower （P〈0.05）.There were 14 patients had abnormal motion of IS,and 14 patients showed abnormal myocardium enhancement.The numbers of abnormal myocardium enhancement was significantly more and right ventricular functions （EDD,EDV,SF,EF） significantly impaired in abnormal motion of IS group compared with those in normal group.Conclusions The impairment of right ventricular function is more severe compared with left ventricular function in patients with CHD complicated with PAH,especially with abnormal motion of IS.The patients with abnormal motion of IS are mostly with abnormal myocardium enhancement.CMR has definite value in the assessment of cardiac function and prognosis in patients with CHD complicated with PAH.