三维高分辨力磁共振钆延迟增强成像评估心房颤动患者左心房心肌纤维化的可行性研究

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中文摘要：目的:探讨三维高分辨力磁共振钆延迟增强成像(3D-LGE-MRI)评估心房颤动患者左心房心肌纤维化程度及空间分布特征的可行性.方法:回顾性收集 2021 年 5 月至 2023 年 2 月于中国医学科学院阜外医院行杂交心房颤动消融术前采用左心房3D-LGE-MRI评估左心房心肌纤维化的心房颤动患者 34 例.2 名放射诊断医师(医师 1 和医师 2)双盲分别对图像质量进行 4 分法评价,均使用ADAS后处理软件测量左心房壁及钆延迟增强(LGE)面积,并计算LGE面积占比.其中1 名医师再进行分区分析,将左心房壁分为 10 区,测量每个分区的心房壁面积及LGE面积,并计算LGE面积占比.使用Kappa检验评价医师1和医师2图像质量评分的一致性,采用组内相关系数评价LGE定量参数的观察者间一致性.另使用独立样本t检验或Mann-Whitney U检验比较持续性与阵发性心房颤动患者的左心房形态学参数、LGE程度及空间分布特征.结果:34 例患者均完成左心房 3D-LGE-MRI扫描并获得具有诊断价值图像.医师 1 和医师 2 对图像总体质量的主观评分分别为(2.88±0.64)分和(2.97±0.58)分,左心房壁清晰度的主观评分分别为(3.26±0.75)分和(3.24±0.70)分,Kappa值分别为 0.724 和 0.859.LGE面积及LGE面积占比在观察者(医师 1 和医师 2)间具有良好的一致性,组内相关系数达 0.969 和 0.950.阵发性和持续性心房颤动患者间左心房壁LGE面积及LGE面积占比差异均无统计学意义(P均＞0.05).与阵发性心房颤动患者比,持续性心房颤动患者具有更高的犹他分期和更为严重的右下肺静脉及左心房间隔区域纤维化,差异均有统计学意义(P均＜0.05).结论:3D-LGE-MRI可应用于三维可视化及定量评估心房颤动患者的左心房心肌纤维化,可为心房颤动患者个体化治疗方案的制定提供参考.持续性心房颤动患者的左心房纤维化程度较阵发性心房颤动患者更严重,二者差异主要表现在右下肺静脉及左心房间隔区域.

外文标题：Left Atrial Myocardial Fibrosis Assessment by 3D High-resolution Late Gadolinium Enhancement MRI in Patients With Atrial Fibrillation:a Feasibility Study

外文摘要：Objectives:To investigate the clinical feasibility of three-dimensional(3D)high-resolution late gadolinium enhancement(LGE)MRI in accessing left atrial myocardial fibrosis in patients with atrial fibrillation(AF).Methods:A total of 34 AF patients referred for hybrid surgical ablation were retrospectively enrolled in this study.3D-LGE-MRI images were acquired by Siemens 3.0 T machine and analyzed by ADAS post-processing software by two experienced radiologists to obtain parameters such as the area and the area percentage of LGE.Regional analysis was performed by one of the two radiologists at ten left atrial segments.The Kappa test was used to assess the agreement for scoring image quality,and the interclass correlation coefficient(ICC)was used to evaluate the interobserver agreement of LGE parameters.The parameters of left atrial morphology,area(and area percentage)of LGE,and location of LGE were compared between patients with persistent AF and paroxysmal AF.Results:Images of all 34 patients were considered to have diagnostic value.The scores of the overall image quality and the clarity of the left atrial wall evaluated by two radiologists were(2.88±0.64)points and(3.26±0.75)points(radiologist 1),(2.97±0.58)points and(3.24±0.70)points(radiologist 2),respectively.The corresponding Kappa values were 0.724 and 0.859.Both the area and the area percentage of LGE showed good consistency among observers,and the ICCs were 0.969 and 0.950,respectively.The difference in the area of LGE and the area percentage of LGE between patients with paroxysmal and persistent atrial fibrillation was similar(both P＞0.05).Compared with patients with paroxysmal AF,patients with persistent AF had a higher Utah stage and more severe myocardial fibrosis in the right inferior pulmonary vein antrum and the left atrial septum(all P＜0.05).Conclusions:3D high-resolution LGE-MRI provides a non-invasive way to visualize and quantify left atrial myocardial fibrosis.The extent of left atrial fibrosis in patients with persistent AF is more severe than that in patients with paroxysmal AF,with a preferential distribution in the right inferior pulmonary vein antrum and the left atrial septum.

外文关键词：

magnetic resonance imagingatrial fibrillationlate gadolinium enhancementmyocardial fibrosis

作者：

朱乐怡、袁硕、王艺宁、安康、杨文静、李浩杰、尹刚、赵世华、陆敏杰、郑哲

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作者单位：

中国医学科学院北京协和医学院国家心血管病中心阜外医院磁共振影像科,北京 100037

中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京 100037

关键词：

磁共振成像心房颤动钆延迟增强心肌纤维化

基金：

中国医学科学院临床与转化医学研究基金中国医学科学院重点实验室建设项目高水平医院临床研究青年重点项目国家外国专家人才类项目中国医学科学院医学与健康科技创新工程项目

项目编号：

2019XK3200632019PT3100252022-GSP-QZ-5G2021194020L2021-I2M-1-063

出版年：

2024

DOI：

10.3969/j.issn.1000-3614.2024.07.008

中国循环杂志

中国医学科学院

中国循环杂志

CSTPCD北大核心

影响因子：2.803

ISSN：1000-3614

年,卷(期)：2024.39(7)