心脏磁共振快速评估右心室收缩功能方法在常见原发性心肌病的应用
工作特征曲线（ROC曲线）评估RVEF<45%时各参数的阈值及诊断准确性。 结果 RVEDV/BSA、RVESV/BSA、TAPSE、RVFS及RVFAC 在IDCM RVEF≥45%（58例）与RVEF<45%（37例）时有统计学差异（P < 0.05）。ROC曲线评估各快速测量方法在诊断RVEF<45%时均具有较高的诊断准确性，TAPSE、RVFS、RVFAC及目测评估的曲线下面积分别为0.91、0.95、0.94、0.91（医师1）、0.93（医师2），P均< 0.05;且均具有较高的灵敏度（分别为TAPSE 78%，RVFS 73%，RVFAC 86%，医师1 84%，医师2 86%）、特异度（分别为TAPSE 88%，RVFS 100%，RVFAC 93%，医师1 98%，医师2 100%），其中RVFAC的灵敏度、特异度最均衡且诊断准确性较高。结论 CMR快速评估常见原发性心肌病患者右心室收缩功能的方法具有较高的诊断准确性，可以选择任一种以快速评估右心室收缩功能，以RVFAC为最佳。
【关键词】 心脏磁共振;右心室功能;原发性扩张型心肌病;肥厚型心肌病
【Abstract】 Objective To compare the accuracy of different magnetic resonance methods in the rapid assessment of the right ventricular systolic function， aiming to explore the most rapid and effective assessment approach. Methods The cardiac magnetic resonance （CMR） imaging data of 95 patients with idiopathic cardiomyopathy including 52 cases of idiopathic dilated cardiomyopathy and 43 cases of hypertrophic cardiomyopathy were retrospectively analyzed. On the basis of CVI42 processing software， the right ventricular ejection fraction （RVEF） was measured by the traditional gold standard. The tricuspid annular plane systolic excusion （TAPSE）， right ventricular fractional shortening （RVFS） and right ventricular fractional area change （RVFAC） were measured by rapid assessment method. The right ventricular systolic function was measured by visual assessment method. The threshold and diagnostic accuracy of each parameter when diagnosing RVEF < 45% were analyzed by the receiver operating characteristic （ROC） curve. Results The RVEDV/BSA， RVESV/BSA， TAPSE， RVFS and RVFAC significantly differed between 58 cases with RVEF≥45% and 37 cases with RVEF<45% （all P < 0.05）. When the RVEF < 45%， the ROC curve revealed that the diagnostic accuracy of each rapid assessment method was relatively high. The area under curve of TAPSE， RVFS， RVFAC and visual assessment were 0.91， 0.95， 0.94， 0.91（Doctor 1） and 0.93（Doctor 2）， respectively. All these rapid assessment methods yielded relatively high sensitivity （78% for TAPSE， 73% for RVFS， 86% for RVFAC， 84% for Doctor 1 and 86% for Doctor 2）and high specificity （88% for TAPSE， 100% for RVFS， 93% for RVFAC， 98% for Doctor 1 and 100% for Doctor 2）. RVFAC had the highest diagnostic accuracy and the most balance between sensitivity and specificity. Conclusions The CMR rapid assessment method yields relatively high diagnostic accuracy in the evaluation of the right ventricular systolic function in patients with common idiopathic cardiomyopathy. Any parameter can be chosen to rapidly assess the right ventricular systolic function， and RVFAC is the optimal parameter.