磁共振成像定量检测扩张型心肌病左心室功能及其与NYHA分级的相关性

doi:10.3969/j.issn.1671-7171.2023.04.011

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摘要【目的】探讨磁共振成像定量检测扩张型心肌病左心室功能指标及其与美国纽约心脏病协会(NYHA)分级的相关性。【方法】选取2018年5月至2020年5月在榆林市星元医院诊治的98例扩张型心肌病患者(观察组),根据NYHA分级分为Ⅰ~Ⅱ级组(n=22例)、Ⅲ级组(n=42例)、Ⅳ级组(n=34例),另选取同期来院体检的92例健康者(对照组)。采用磁共振成像定量检测左心室功能,包括左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF),比较扩张型心肌病患者与健康体检者心室功能指标,比较扩张型心肌病不同NYHA分级患者心室功能指标,采用Spearman相关性分析扩张型心肌病患者LVEDV、LVESV、LVEF与NYHA分级的关系。随访1年,比较不同预后的患者心室功能指标,采用受试者工作特征(ROC)曲线分析LVEDV、LVESV、LVEF预测扩张型心肌病患者死亡的价值。【结果】观察组LVEDV、LVESV均高于对照组(P<0.05),LVEF低于对照组(P<0.05)。Ⅳ级组患者LVEDV、LVESV均高于Ⅰ~Ⅱ级组、Ⅲ级组(P<0.05),Ⅲ级组患者LVEDV、LVESV均高于Ⅰ~Ⅱ级组(P<0.05),Ⅳ级组患者LVEF低于Ⅰ~Ⅱ级组和Ⅲ级组(P<0.05),Ⅲ级组患者LVEF低于Ⅰ~Ⅱ级组(P<0.05)。Spearman相关性分析显示,扩张型心肌病患者LVEDV、LVESV与NYHA分级均呈正相关(P<0.05),LVEF与NYHA分级呈负相关(P<0.05)。死亡患者LVEDV、LVESV均高于存活患者(P<0.05),LVEF低于存活患者(P<0.05)。ROC曲线分析显示,LVEDV、LVESV、LVEF预测扩张型心肌病患者死亡的最佳截断点分别为234.11 mL、179.15 mL、25.53%,曲线下面积(AUC)分别为0.803、0933、0.897。【结论】扩张型心肌病患者LVEDV、LVESV均异常升高,LVEF异常降低,LVEDV、LVESV、LVEF均与扩张型心肌病患者NYHA分级有关,磁共振成像定量检测左心室功能指标可作为评估患者预后的敏感指标。

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	张学平
	王军

关键词 ：心肌病,扩张型, 磁共振成像, 心室功能,左, 数据相关性

Abstract：【Objective】 To investigate the correlation between quantitative detection of left ventricular function by magnetic resonance imaging (MRI) in patients with dilated cardiomyopathy and the New York Heart Association (NYHA) classification. 【Methods】 A total of 98 patients with dilated cardiomyopathy admitted to Xingyuan Hospital of Yulin from May 2018 to May 2020 (observation group) were selected and divided into Grade Ⅰ to Grade Ⅱ groups (n=22 cases),Grade Ⅲ group (n=42 cases),and Grade Ⅳ group (n=34 cases) according to NYHA classification. In addition,92 healthy individuals (control group) who came to Xingyuan Hospital of Yulin for physical examination during the same period were selected. Magnetic resonance imaging was used to quantitatively detect left ventricular function,including left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),and left ventricular ejection fraction (LVEF). The ventricular function indexes of patients with dilated cardiomyopathy and healthy subjects were compared,and the ventricular function indexes of patients with different NYHA grades of dilated cardiomyopathy were compared. Spearman correlation analysis was used to analyze LVEDV,LVESV The relationship between LVEF and NYHA grading. During a one-year follow-up period,the ventricular function indicators of patients with different prognosis were compared,and the value of LVEDV,LVESV,and LVEF in predicting death in patients with dilated cardiomyopathy was analyzed using subject working curve (ROC). 【Results】 LVEDV and LVESV in the observation group were higher than those in the control group (P<0.05),while LVEF was lower than that in the control group (P<0.05). The LVEDV and LVESV of patients in the Grade Ⅳ group were higher than those in the Grade Ⅰ~Ⅱ groups and the Grade Ⅲ group (P<0.05),while the LVEDV and LVESV of patients in the Grade Ⅲ group were higher than those in the Grade Ⅰ~Ⅱ groups (P<0.05); the LVEF of patients in grade Ⅳ group was lower than that in the Grade Ⅰ~Ⅱ groups and the Grade Ⅲ group (P<0.05),while the LVEF of patients in the Grade Ⅲ group was lower than that in the Grade Ⅰ~Ⅱ groups (P<0.05). Spearman correlation analysis showed that there was a positive correlation between LVEDV,LVESV,and NYHA grading in patients with dilated cardiomyopathy (P<0.05),while there was a negative correlation between LVEF and NYHA grading (P<0.05). The LVEDV and LVESV of the dead patients were higher than those of the surviving patients (P<0.05),and the LVEF was lower than those of the surviving patients (P<0.05). ROC curve analysis showed that the best cutoff points for predicting death in patients with dilated cardiomyopathy were 234.11 mL,179.15 mL,and 25.53% for LVEDV,LVESV,and LVEF,respectively. The area under the curve (AUC) was 0.803,0933,and 0.897,respectively. 【Conclusion】 LVEDV,LVESV,and LVEF in patients with dilated cardiomyopathy are abnormally elevated,while LVEF is abnormally decreased. LVEDV,LVESV,and LVEF are all related to NYHA classification in patients with dilated cardiomyopathy. Quantitative detection of left ventricular function using magnetic resonance imaging can be used as a sensitive indicator for evaluating the prognosis of patients.

Key words： Cardiomyopathy,Dilated Magnetic Resonance Imaging Ventricular Function,Left Correlation of Data

收稿日期: 2022-02-14

中图分类号:

R542.2

通讯作者: * E-mail:964764025@qq.com

引用本文:

张学平, 王军. 磁共振成像定量检测扩张型心肌病左心室功能及其与NYHA分级的相关性[J]. 医学临床研究, 2023, 40(4): 519-522.
ZHANG Xue-ping, WANG Jun. Quantitative Detection of Left Ventricular Function by Magnetic Resonance Imaging in Patients with Dilated Cardiomyopathy and its Correlation with NYHA Classification. JOURNAL OF CLINICAL RESEARCH, 2023, 40(4): 519-522.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.04.011 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I4/519

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