摘要/Abstract

摘要： 目的·利用心血管磁共振（cardiovascular magnetic resonance，CMR）评价体质量指数（body mass index，BMI）和肥厚型心肌病（hypertrophic cardiomyopathy，HCM）患者左心室结构和功能的相关性。方法·纳入2016年1月至2020年12月就诊于上海交通大学医学院附属仁济医院心内科的HCM患者92例（HCM组）、健康对照22例（对照组），在心内科医师和放射科医师联合监督下完成CMR检查。HCM患者按照BMI水平分成3个亚组：正常体质量亚组（BMI<24.00 kg/m²）20例、超重亚组（24.00 kg/m²≤BMI<28.00 kg/m²）43例和肥胖亚组（BMI≥28.00 kg/m²）29例。比较HCM组与对照组患者以及HCM亚组间患者的CMR结构和功能指标，主要包括左心室舒张末期容积（left ventricular end-diastolic volume，LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume，LVESV）、左心室射血分数（left ventricular ejection fraction，LVEF）、左心室心肌质量指数（left ventricular mass index，LVMI）以及心肌整体纵向应变（global longitudinal strain，GLS）。通过逐步多重线性回归分析评价HCM患者BMI与GLS的关系。结果·与对照组相比，HCM组的LVEF、LVMI均升高（P=0.001，P=0.000），心肌GLS降低（P=0.000）。HCM亚组间比较发现，超重亚组及肥胖亚组较正常体质量亚组LVEDV升高（均P=0.000），左心室心肌GLS降低（P=0.005，P=0.000）。逐步线性回归分析提示，校正年龄等因素后，BMI是左心室心肌GLS的独立预测因素（β=-0.431，P=0.000）；随着BMI的升高，GLS逐渐降低。结论·BMI与HCM患者的左心室结构和功能负相关。减轻体质量，将BMI维持在正常范围，可能有助于改善HCM患者的心功能状态和临床预后。
关键词: 肥厚型心肌病, 心血管磁共振, 体质量指数, 整体纵向应变
Abstract:
Objective·To evaluate the relation between body mass index (BMI) and left ventricular structure and function in patients with hypertrophic cardiomyopathy (HCM) through cardiovascular magnetic resonance (CMR).
Methods·Twenty-two healthy people (control group) and 92 consecutive patients with HCM (HCM group) who received treatment in the Department of Cardiology of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included from January 2016 to December 2020, and all participants completed CMR examination under the scrutiny of cardiologists and radiologists. Patients with HCM were grouped according to BMI index: the normal BMI subgroup (BMI<24.00 kg/m²), the overweight subgroup (24.00 kg/m²≤BMI<28.00 kg/m²) and the obesity subgroup (BMI≥28.00 kg/m²). The structural and functional indexes of CMR between the HCM group and the control group and among the three HCM subgroups were compared, including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) and global longitudinal strain (GLS). The relationship between BMI and GLS was explored by stepwise linear analysis.
Results·The HCM group had higher LVEF (P=0.001), higher LVMI (P=0.000) and lower GLS (P=0.000) compared with the control group. LVEDV increased (both P=0.000) and GLS decreased (P=0.005, P=0.000) in the overweight and the obesity subgroup compared with the normal BMI subgroup. In the stepwise linear regression, it suggested that BMI in patients with HCM was associated with decreased GLS independently after being adjusted for age (β=-0.431, P=0.000).
Conclusion·BMI is negatively correlated with the left ventricular structure and function in patients with HCM. Losing weight to keep BMI in normal range may help to improve left ventricular function and clinical prognosis.

Key words: hypertrophic cardiomyopathy (HCM), cardiovascular magnetic resonance (CMR), body mass index (BMI), global longitudinal strain (GLS)


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