电邮这篇文章 在肥厚型心肌病术前诊断中心脏计算机断层扫描的诊断能力
- 作者: Dariy O.Y.1,2, Yurpolskaya L.A.1, Rychina I.E.1, Dorofeev A.V.1, Golukhova E.Z.1
-
隶属关系:
- Bakulev Scientific Center for Cardiovascular Surgery
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies
- 期: 卷 5, 编号 3 (2024)
- 页面: 467-479
- 栏目: 原创性科研成果
- URL: https://bakhtiniada.ru/DD/article/view/310030
- DOI: https://doi.org/10.17816/DD629141
- ID: 310030
如何引用文章
全文:
详细
论证。借助各种诊断设备和最新扫描技术研究肥厚型心肌病的综合方法，将确保肥厚型心肌病患者的高质量控制和有效治疗。为了研究左心室重构的表型变异，并与二尖瓣的腱索乳头肌和心肌结构的异常相结合，在新一代扫描仪上引入创新的技术和计算机的计算，具有现实意义和前景。
目的 — 研究在肥厚型心肌病表型术前诊断中计算机断层扫描的能力。
材料和方法。对47名肥厚型心肌病患者（平均年龄为52±7周岁）的术前矫正数据进行回顾性分析。为了研究心房、冠状动脉的异常和二尖瓣的形态，我们采用了自己开发的规程和阈值为90HU双相注射造影剂，自动监测左心房腔内的造影剂团。为了研究心肌的结构变化，利用构建延迟对比碘图对双能量计算机断层扫描获得的数据进行分析。所有肥厚型心肌病患者都被分为不同的形态学类型。 对每个病例的脉络-乳头器的解剖结构进行了评估。
结果。我们的研究表明肥厚型心肌病表型体现的易变性，通常可分为5种形态类型，但并不局限于这些变体。26名患者（55%）具有肥厚型心肌病的弥漫性隔膜形态表型。 5名患者（11%）发现室间隔表型，其中2名患者 （4%）的室间隔表型伴有左心室心尖部隆起/动脉瘤。 8名患者（18%）发现局灶性基底表型，4名患者（8%）发现同心表型，另有4名患者（8%）发现了心尖部表型。大多数患者被诊断为二尖瓣腱索乳头肌异常，分为乳头肌数量和位置异常，以及腱索与肌肉比例异常。10名患者（21%）的冠状动脉心内走行，其中3 名患者（14%）发现动态狭窄迹象。所有患者在延迟对比图上都显示出局灶性碘沉积。13名患者中10名（76%）的ECV细胞外体积分数值超过正常范围。双能量计算机断层扫描显示的平均左心室心肌ECV为30.58%（95%置信区间为27-34%）。
结论。我们在各代计算机断层扫描仪上开发的扫描规程，使其能够在一项研究中确定肥厚性心肌病形态类型的特征模式，并详细解释心脏的心室和瓣膜系统的几何形状、左心室的功能和冠状动脉床的状态，以及左心室心肌的结构变化。
关键词
作者简介
Olga Y. Dariy
Bakulev Scientific Center for Cardiovascular Surgery; Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies
Email: dariiolyka@mail.ru
ORCID iD: 0000-0003-0140-8166
SPIN 代码: 1844-4944
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Moscow; MoscowLiudmila A. Yurpolskaya
Bakulev Scientific Center for Cardiovascular Surgery
Email: layurpolskaya@bakulev.ru
ORCID iD: 0000-0001-7780-2405
SPIN 代码: 8436-9665
MD, Dr. Sci. (Medicine)
俄罗斯联邦, MoscowInna E. Rychina
Bakulev Scientific Center for Cardiovascular Surgery
Email: ierychina@bakulev.ru
ORCID iD: 0000-0001-8056-4188
SPIN 代码: 3516-0729
MD, Cand. Sci. (Medicine)
俄罗斯联邦, MoscowAleksey V. Dorofeev
Bakulev Scientific Center for Cardiovascular Surgery
Email: avdorofeev@bakulev.ru
ORCID iD: 0000-0003-0833-9650
MD, Cand. Sci. (Medicine)
俄罗斯联邦, MoscowElena Z. Golukhova
Bakulev Scientific Center for Cardiovascular Surgery
编辑信件的主要联系方式.
Email: egolukhova@bakulev.ru
ORCID iD: 0000-0002-6252-0322
SPIN 代码: 9334-5672
MD, Dr. Sci. (Medicine), Academician of Russian Academy of Science
俄罗斯联邦, Moscow参考
- Maron BJ, McKenna WJ, Danielson GK, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2003;42(9):1687–1713. doi: 10.1016/s0735-1097(03)00941-0
- Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg. 2017;6(4):329–336. doi: 10.21037/acs.2017.07.03
- Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circultation. 2020;142(25):e558–e631. doi: 10.1161/CIR.0000000000000937
- Brigden W. Uncommon myocardial diseases: the non-coronary cardiomyopathies. Lancet. 1957;273(7008):1243–1249. doi: 10.1016/s0140-6736(57)91537-4
- Choudhury L, Mahrholdt H, Wagner A, et al. Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002;40(12):2156–2164. doi: 10.1016/S0735-1097(02)02602-5
- Shiozaki AA, Senra T, Arteaga E, et al. Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy. J Cardiovasc Comput Tomogr. 2013;7(3):173–181. doi: 10.1016/j.jcct.2013.04.002
- Qin L, Chen C, Gu S, et al. A radiomic approach to predict myocardial fibrosis on coronary CT angiography in hypertrophic cardiomyopathy. International Journal of Cardiology. 2021;337:113–118. doi: 10.1016/j.ijcard.2021.04.060
- Berliner JI, Kino A, Carr JC, Bonow RO, Choudhury L. Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging. 2013;29(1):191–197. doi: 10.1007/s10554-012-0048-y
- Bokeriya LA. Hypertrophic obstructive cardiomyopathy. Annals of Surgery (Russia). 2013;5:5–14. (In Russ).
- Baxi AJ, Restrepo CS, Vargas D, et al. Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics. 2016;36:335–354. doi: 10.1148/rg.2016150137
- Efthimiadis GK, Pagourelias ED, Hadjimiltiades S, et al. Feasibility and significance of preclinical diagnosis in hypertrophic cardiomyopathy. Cardiol Rev. 2015;23(6):297–302. doi: 10.1097/CRD.0000000000000076
- Vasil’ev YuA, Semenov DS, Akhmad ES, et al. Peculiarities of magnetic resonance imaging in patients with implants and metal structures. Moscow: Obshchestvo s ogranichennoi otvetstvennost’yu «Izdatel’skie resheniya»; 2022. (In Russ.) EDN: WNQXXM
- Bandula S, White SK, Flett AS, et al. Measurement of myocardial extracellular volume fraction by using equilibrium contrast-enhanced CT: validation against histologic findings. Radiology. 2013;269(2):396–403. doi: 10.1148/radiology.13130130
- Bokeriya LA, Darii OYu, Makarenko VN, et al. Computed and magnetic resonance imaging of hypertrophic cardiomyopathy. Educational and methodological manual. Moscow: Natsional’nyi meditsinskii issledovatel’skii tsentr serdechno-sosudistoi khirurgii imeni A.N. Bakuleva; 2022. (In Russ.) EDN: MOGFHL
- Patel P, Dhillon A, Popovic Z, et al. Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients without severe septal hypertrophy: implications of mitral valve and papillary muscle abnormalities assessed using cardiac magnetic resonance and echocardiography. Circ Cardiovasc Imaging. 2015;8(7):e003132. doi: 10.1161/CIRCIMAGING.115.003132
- Laaroussi L, Ben Halima A, Boukhris M. Left ventricular non-compaction associated with hypertrophic cardiomyopathy in the same patient. Kardiol Pol. 2017;75(4):397. doi: 10.5603/KP.2017.0064
- Wigle ED, Auger P, Marquis Y. Muscular subaortic stenosis: the initial left ventricular inflow tract pressure as evidence of outflow tract obstruction. Can Med Assoc J. 1966;95(16):793–797.
- Ramsheyi SA, Pargaonkar S, Lassau JP, Acar C. Morphologic classification of the mitral papillary muscles. J Heart Valve Dis. 1996;5(5):472–476.
- Kovalevskaya EA, Krylova NS, Poteshkina NG, et al. Clinical profile of patients with hypertrophic cardiomyopathy with myocardial ischemia in the absence of coronary atherosclerosis. The journal of general medicine. 2018;(4):36–42. EDN: VVQBKY
- Abadia A, Assen M, Martin S, et al. Myocardial extracellular volume fraction to differentiate healthy from cardiomyopathic myocardium using dual-source dual-energy CT. Journal of Cardiovascular Computed Tomography. 2020;14(2):162–167. doi: 10.1016/j.jcct.2019.09.008
- Vullaganti S, Levine J, Raiker N, et al. Fibrosis in Hypertrophic Cardiomyopathy Patients With and Without Sarcomere Gene Mutations. Heart Lung Circ. 2021;30(10):1496–1501. doi: 10.1016/j.hlc.2021.04.008
补充文件
附件文件
动作
1.
JATS XML
2.
Fig. 1. Image of pre-monitoring computed tomography and monitoring graph: a — setting for automatic monitoring of contrast agent bolus in the left atrium with a bolus threshold of 90 HU; b — example of contrast agent bolus monitoring graph.
下载 (119KB)
3.
Fig. 2. An example of post-processing of images of computed tomography of the heart of a patient with hypertrophic cardiomyopathy. Visualization of the cavities of the heart, coronary arteries and heads of the papillary muscles: a — 3D reconstruction of the four-chamber projection of the heart; b — 3D reconstruction of the coronary arteries; c — multiplanar reconstruction in the two-chamber projection of the heart. LA — left atrium, LV — left ventricle, RA — right atrium, RV — right ventricle.
下载 (245KB)
4.
Fig. 3. Iodine maps of dual-energy computed tomography: a — four-chamber projection of the heart (ROI — measurement of iodine distribution in the left ventricular cavity and interventricular septum); b — short axis of the heart (ROI — measurement of iodine distribution in the left ventricular cavity and along the interventricular septum).
下载 (181KB)
5.
Fig. 4. Example of 3D images of computed tomography of the diffuse-septal phenotype of HCM: a — plane of the two-chamber projection of the left heart; b — short axis of the heart; c — four-chamber projection of the heart. LV — left ventricle, LA — left atrium, RV — right ventricle, RA — right atrium.
下载 (282KB)
6.
Fig. 5. Example of MPR and 3D CT images of the midventricular phenotype of hypertrophic cardiomyopathy with signs of systolic cavity obstruction due to a variant anomaly of the chordopapillary apparatus and asymmetric hypertrophy of the left ventricular myocardium: a - plane of the two-chamber projection of the left heart; b - three-chamber projection of the heart; c - four-chamber projection of the heart. Apical displacement of the posterolateral papillary muscle and direct contact with the anterior leaflet of the mitral valve; splitting of the papillary muscle legs + accessory muscular trabecula.
下载 (256KB)
7.
Fig. 6. Example of 3D-images of computed tomography of the focal-basal phenotype of hypertrophic cardiomyopathy: a — plane of two-chamber projection of the left heart; b — short axis of the heart. LV — left ventricle; LA — left atrium; RV — right ventricle; IVS — interventricular septum; Ao — aorta.
下载 (265KB)
8.
Fig. 7. Example of MPR and 3D CT images of a patient with the apical phenotype of hypertrophic cardiomyopathy after implantation of a cardioverter-defibrillator: a — plane of the four-chamber projection; b — two-chamber projection of the left heart; c — 3D VRT reconstruction of the four-chamber projection of the heart.
下载 (260KB)
9.
Fig. 8. An example of visual assessment of focal iodine accumulation in segments of the myocardium of the th ventricle based on the iodine map of dual-energy computed tomography: a — short axis of the heart; b — axial projection of the heart.
下载 (186KB)
