【摘要】 目的 探讨心脏磁共振延迟强化技术(CMR-LGE)定量评估二尖瓣病变患者心肌纤维化的临床价值，并比较不同病变类型患者的纤维化特征与心功能关系。方法 收集2013年1月至2019年11月期间就诊于四川大学华西医院的二尖瓣病变患者105例，经筛选后纳入58例单纯性二尖瓣病变患者(二尖瓣狭窄27例，二尖瓣反流31例),同时纳入42例健康对照者。所有患者进行心脏磁共振检查，使用CMR-LGE延迟强化图像，通过Cvi42软件定量评估左心室心肌纤维化程度，分析其节段分布特征及与心功能、心肌应变参数的关系。结果 二尖瓣反流患者的延迟强化率明显高于二尖瓣狭窄患者(χ~2=8.512,P=0.004),室间隔延迟强化程度(29.99±17.14)%显著高于前壁(22.70±17.75)%和侧壁[(21.76±17.65)%F=4.91,P=0.012]。二尖瓣反流患者重度延迟强化组左心室射血分数较轻中度组显著降低，延迟强化体积比例(LGEv)与左心室射血分数呈负相关(r=-0.69,P=0.010)。与非延迟强化组相比，延迟强化组左心室舒张末期容积增大[(207.05±82.74)mL vs (167.42±73.02) mL,F=5.26,P=0.023],心肌质量及重构指数明显下降。重度延迟强化组心肌整体及心中间部峰值径向应变和周向应变较轻中度组显著降低(P<0.05)。结论 CMR-LGE能定量评估MVD患者心肌纤维化的分布特征及程度，对评估疾病严重程度及预后具有重要临床价值。更多还原

【Abstract】 Objective To explore the clinical value of cardiac magnetic resonance late gadolinium enhancement(CMR-LGE) in quantitative assessment of myocardial fibrosis in patients with mitral valve disease(MVD),and compare the relationship between fibrosis characteristics and cardiac function in patients with different types of MVD.Methods A total of 105 patients with MVD in West China Hospital of Sichuan University from January 2013 to November 2019 were enrolled.After screening, 58 isolated patients [27 with mitral stenosis(MS) and 31 with mitral regurgitation(MR)] and 42 healthy controls were included.All participants underwent CMR-LGE examination, and Cvi42 post-processing software was used to evaluate the extent of left ventricular myocardial fibrosis and analyze its segmental distribution and correlation with cardiac function and strain parameters.Results The incidence of LGE in patients with MR was significantly higher than that in patients with MS(χ~2=8.512,P=0.004).The extent of septal LGE(29.99±17.14)% was significantly greater than that of the anterior wall(22.70±17.75)% and lateral wall [(21.76±17.65)%,F=4.91,P=0.012].Left ventricular ejection fraction(LVEF) was significantly lower in severe LGE group than in mild/moderate group, and LGE volume ratio showed significant negative correlation with LVEF(r=-0.69,P=0.01).The LGE group showed increased left ventricular end-diastolic volume[(207.05±82.74) ml vs(167.42±73.02) ml, F=5.26,P=0.023],with decreased myocardial mass and remodeling index compared with non-LGE group.The global and mid-ventricular peak radial strain and circumferential strain were significantly reduced in severe LGE group compared with mild/moderate group(P < 0.05).Conclusion CMR-LGE can quantify the distribution and extent of myocardial fibrosis in patients with MVD,providing important clinical value for assessing disease severity and prognosis.更多还原