孤立性左心室心肌致密化不全患者的心肌灌注显像研究

目的 分析孤立性左心室心肌致密化不全（ILVNC）患者的心肌灌注受损情况,及其与心脏MRI结果之间的关系.方法 前瞻性入选19例（男14例,女5例,年龄15 ～ 76岁）经心脏MRI确诊的ILVNC患者,同期行99Tcm-MIBI SPECT MPI.采用标准的17节段法分析MRI及SPECT图像.计算MRI所示各节段心肌非致密层（NC）与致密层（C）厚度比值（NC/C）,NC/C＞2.3者诊断为心肌致密化不全.计算并比较致密不全节段和致密化节段延迟强化（DE）出现率及心肌灌注异常的出现率.两样本率的比较采用χ^2检验;lgLVEF（LVEF由MRI测定）和心肌灌注受损节段数、致密化不全节段数和DE节段数的关系采用Pearson或Spearman法分析.结果 19例患者中16例（84.2％） MPI出现灌注受损;MRI示19例共有致密化不全节段107个和致密化节段216个,灌注异常出现率分别为33.6％（36/107）和31.9％（69/216）,差异无统计学意义（χ^2=0.09,P＞0.05）.共31个节段出现DE,致密化不全节段和致密化节段DE出现率分别为5.6％（6/107）和11.6％ （25/216）,差异也没有统计学意义（χ^2=2.94,P＞0.05）.DE节段灌注异常出现率高于非DE节段54.8％（17/31）与30.1％（88/292）;χ^2=7.80,P＜0.01].lgLVEF与致密化不全节段数、DE节段数、灌注受累节段数间相关系数均无统计学意义（r=-0.35、0.15和-0.34,均P＞0.05）.结论 大部分ILVNC患者存在不同程度的心肌血流灌注受损,MRI所示致密化不全和非致密化不全心肌均可出现;心肌灌注受损在该病的发生及进展中的作用尚需进一步研究.

Myocardial perfusion abnormalities in patients with isolated left ventricular noncompaction

Objective To investigate the myocardial perfusion abnormalities in patients with isolated left ventricular noncompaction （ILVNC） and analyze the correlation between MPI and MRI.Methods Nineteen patients （14 males,5 females,age range：15-76 years） with ILVNC diagnosed by cardiac MRI were recruited.All patients underwent 99Tcm-MIBI MPI.Both MPI and cardiac MRI were analyzed using a 17-segment model.The thickness ratio of the non-compacted to compacted layers of myocardium （NC/C） was calculated,and segments with NC/C＞2.3 were considered as noncompaction.The incidences of delayed enhancement （DE） and myocardial perfusion abnormalities in non-compacted segments and compacted segments were calculated.χ^2 test was used for categorical data.The Pearson and Spearman correlation coefficient were used to assess the relationship between the numbers of myocardial segments with myocardial perfusion abnormalities/noncompaction/DE and lgLVEF.Results Of 19 patients,myocardial perfusion abnormality was found in 16 （84.2％） patients.The incidences of perfusion abnormality were 33.6％ （36/107） in non-compacted segments and 31.9％ （69/216） in compacted segments,respectively （χ^2=0.09,P＞0.05）.There were 31 segments with DE.The incidences of DE were 5.6％ （6/107） in non-compacted segments and 11.6％ （25/216） in compacted segments,respectively （χ^2 =2.94,P＞0.05）.The incidence of reduced perfusion was higher in segments with DE than those in segments without DE （54.8％ （17/31） vs 30.1％ （88/292） ; χ^2 =7.80,P＜0.01）.The lgLVEF and the numbers of myocardial segments with noncompaction/DE/myocardial perfusion abnormalities were not correlated（r=-0.35,0.15,-0.34,all P＞0.05）.Conclusion Most patients with ILVNC have myocardial perfusion abnormality,which can be observed both in non-compacted and compacted myocardium.Further research is required to elucidate the role of myocardial perfusion abnormality in ILVNC.