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目的探讨心脏磁共振电影成像在评价射血分数保留心力衰竭(HFpEF)左心室舒张功能中的作用。方法应用心脏磁共振成像获取30例HFpEF患者和15例心功能正常者(对照组)的左心室长轴两腔、三腔、四腔及系列短轴电影图像,绘制左心室容积-时间曲线(VTC)及整体应变曲线,比较两组峰值充盈速率及充盈量,以及整体纵向、径向、周向峰值应变和应变率等参数。结果与对照组相比,HFpEF患者左心室重构指数(LVRI)增加(0.86±0.15vs 0.73±0.08,P<0.05),舒张早、晚期峰值充盈速率比(PFR1/PFR2)降低或倒置(0.74±0.14vs 1.43±0.34,P=0.001),早期充盈量(FV1)及其占总充盈量比例降低(26.24±9.74vs 31.30±5.17,0.59±0.05vs 0.69±0.03;P均<0.05),左心室整体纵向峰值应变(GLS)降低[(-14.96±1.79)%vs(-20.96±0.84)%,P<0.01],整体纵向、径向、周向峰值应变率均降低(0.65±0.16vs 1.29±0.27,-2.23±0.71vs-3.80±1.13,1.02±0.14vs 1.77±0.63;P均<0.05)。结论通过心脏磁共振获得的LVRI、PFR1/PFR2、FV1和整体周向峰值应变率能够较准确地反映HFpEF左心室舒张功能的改变,对于HFpEF诊治具有较高的临床价值。
Objective To investigate the role of cardiac magnetic resonance imaging in the assessment of left ventricular diastolic function in patients with preserved ejection fractional heart failure (HFpEF). Methods Left ventricular long-axis two-chamber, three-chamber, four-chamber and series short axis images were obtained from 30 patients with HFpEF and 15 normal heart patients (control group) by cardiac magnetic resonance imaging. Left ventricular volume-time curve VTC) and overall strain curve. The peak filling rate and filling volume of the two groups were compared, and the overall longitudinal, radial, circumferential peak strain and strain rate were compared. Results Compared with the control group, the left ventricular remodeling index (LVRI) of HFpEF patients increased (0.86 ± 0.15 vs 0.73 ± 0.08, P <0.05), and the peak diastolic velocity (PFR1 / PFR2) ± 0.14vs 1.43 ± 0.34, P = 0.001), and the proportion of early filling (FV1) and its total filling decreased (26.24 ± 9.74 vs 31.30 ± 5.17,0.59 ± 0.05 vs 0.69 ± 0.03; P <0.05) The total longitudinal peak strain (GLS) of the ventricle decreased (-14.96 ± 1.79% vs (-20.96 ± 0.84)%, P <0.01] and the overall longitudinal, radial and circumferential peak strain rates decreased (0.65 ± 0.16 vs 1.29 ± 0.27, -2.23 ± 0.71 vs-3.80 ± 1.13, 1.02 ± 0.14 vs 1.77 ± 0.63, P <0.05). Conclusion LVRI, PFR1 / PFR2, FV1 and global circumferential peak strain rate obtained by cardiac magnetic resonance can reflect the change of left ventricular diastolic function of HFpEF more accurately, which has a high clinical value for diagnosis and treatment of HFpEF.