特发性扩张型心肌病右室心肌糖代谢与心功能的相关性研究

摘要

目的 探讨特发性扩张型心肌病(IDCM)患者右室心肌葡萄糖代谢水平与左、右心室功能之间的关系.方法 前瞻性研究2010年10月至2013年5月间确诊的IDCM连续病例64例,其中男45例,女19例,平均年龄(53±12)岁.所有入选者均行18F-FDG心肌代谢PET显像、心脏MRI延迟增强成像(cMRI-LGE)和UCG检查.应用PET-TrueD软件测定右室游离壁SUVmean(SUV-R)和左室游离壁SUVmean(SUV-L),以及两者的比值(SUV-R/L);应用cMRI-LGE测定左、右室功能及左心延迟强化的情况;应用UCG测定肺动脉收缩压(PASP).利用两样本t检验和Pearson相关分析分析数据.结果 SUV-R、SUV-R/L与LVEF均呈负相关(r=-0.48和-0.33,均P＜0.01),与RVEF也呈负相关(r=-0.45和-0.44,均P＜0.01);SUV-R/L与PASP呈正相关(r=0.58,P＜0.01).延迟强化组和无延迟强化组的SUV-R/L分别为0.45±0.18和0.36±0.12,差异有统计学意义(t=2.50,P＜0.05);延迟强化组的SUV-R和SUV-L分别为2.0±0.9和4.7±1.6,无延迟强化组的SUV-R和SUV-L分别为1.7±0.9和5.0±2.8,2组间的SUV-R和SUV-L差异均无统计学意义(t=0.54和0.63,均P＞0.05).结论 右室心肌葡萄糖代谢水平与左、右室功能密切相关,通过PET显像测定右室18F-FDG的摄取,对IDCM患者的病情评估和预后判断具有一定的临床价值.%Objective To explore the relationship between myocardial glucose metabolism in the right heart and cardiac function in patients with idiopathic dilated cardiomyopathy (IDCM).Methods From October 2010 to May 2013,64 consecutive patients (45 males,19 females; mean age:(53 ± 12) years) with IDCM were enrolled in this study.All patients underwent 18F-FDG myocardial PET imaging,late-gadolinium enhancement cardiac MRI (cMRI-LGE) and UCG.TrueD software was used to determine the SUVmax in right (SUV-R) and left (SUV-L) ventricular free wall,and the ratio of SUV-R to SUV-L (SUV-R/L) was calculated.The cMRI-LGE was used to evaluate LVEF,RVEF and LGE in left heart.Pulmonary artery systolic pressure (PASP) was measured by UCG.Two-sample t test and Pearson correlation analysis were used to analyze the data.Results Both SUV-R and SUV-R/L had negative correlation with LVEF (r=-0.48,-0.33; both P＜0.01) and also with RVEF (r=-0.45,-0.44; both P＜0.01).SUV-R/L positively correlated with PASP (r =0.58,P＜0.01).SUV-R/L of patients with and without LGE were statistically different (0.45±0.18 vs 0.36±0.12; t=2.50,P＜0.05).SUV-R and SUV-L of patients with LGE were 2.0±0.9 and 4.7±1.6,and those of patients without LGE were 1.7±0.9 and 5.0±2.8.Both differences of SUV-R and SUV-L between the two groups were not statistically significant (t=0.54 and 0.63,both P＞0.05).Conclusions Myocardial glucose metabolism in right heart is closely correlated with left and right ventricular function.The assessment of 18F-FDG uptake in right heart by PET imaging is potentially useful for evaluation of the severity and prognosis in IDCM patients.