| Objectives:Dilated cardiomyopathy is characterized with left ventricular dilatation and dysfunction, which has a high morbidity and mortality. Cardiac magnetic resonance could be used in noninvasive assessment of ventricular structure, function, perfusion and myocardial viability. Myocardial fibrosis can be identified by the late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). In this study, we investigated the association between left ventricular remodeling, myocardial fibrosis and plasma NT-proBNP levels in patients with dilated cardiomyopathy.Methods:(1)Twenty-two patients who have been diagnosed dilated cardiomyopathy clinically from March 2014 to March 2016 in inpatient department of Cardiology the Second Affiliated Hospital of Kunming Medical University were enrolled. All patients were examined by CMR, coronary angiography (DSA) and/or coronary CTA examination, echocardiography examination and NT-proBNP detection. All the examinations completed in the same time (within a month). The images of left ventricular were transferred to the PHILIPS workstation. Left ventricular structure and function can be calculated. These parameters included LVEDV, LVESV, LVEF, SV, CO, CI, LVMM, FS, LVEDD, and SI.(2)To analyze the correlation between LVEDV, LVESV, LVEF, SV, CO, CI, LVMM, FS, LVEDD, SI and plasma NT-proBNP levels by using SPSS 17.0.(3)According to LGE, the left ventricular myocardial fibrosis, the region of myocardial fibrosis and the number of involved cardiac segments can be evaluated.(4)According to the results of LGE, the patients with DCM were divided into two groups. Group A:without late gadolinium enhancement, group B:with late gadolinium enhancement. The correlation of LVEDV, LVESV, LVEF, SV, CO, CI, LVMM, FS, LVEDD and SI between two groups was analyzed by two independent sample t tests.(5)According to the number of segments involved by myocardial fibrosis, group B was divided into two subgroups. Group a:the number of involved cardiac segments <5, group b:the number of involved cardiac segments≥5. Compared LVEDV, LVESV, LVEF, SV, CO, CI, LVMM, FS, LVEDD, SI and plasma NT-proBNP levels in each group.Result:(1)The plasma NT-proBNP levels in patients with DCM were linear correlation with LVEDV, LVESV, LVEF, LVMM, FS, LVEDD and SI. The plasma NT-proBNP levels were positively correlated with LVEDD (Rs=0.596, P=0.003), LVESD (Rs= 0.742, P=0.000), LVMM (Rs=0.763, P=0.000) and LVEDD (Rs=0.627, P=0.002) and were inversely correlated with LVEF (Rs=-829, P=0.000), FS (Rs=-0.623, P= 0.002) and SI (Rs=-0.539, P=0.010). The correlation between plasma NT-proBNP levels and LVEF was the largest.(2)In the twenty-two patients with DCM, there were sixteen (73%) patients with myocardial fibrosis. The most frequently involved cardiac segments were basal anteroseptal (13 patients) and basal inferoseptal segments (13 patients), followed by mid-anteroseptal (7 patients) and mid-inferoseptal segments (7 patients). Multiple cardiac segments were involved in most of the patients (8 patients). Mid-wall stria involvement was the most frequent type. There were nine patients with mid-wall stria involvement, six patients with subepicardial involvement and only one patient with subendocardial involvement.(3)Compared group A with group B, the differences of LVEDV, LVESV, LVEF, LVMM, FS, LVEDD and SI were considered statistically significant (P<0.05), but the differences of SV, CO and CI were considered no statistically significant (P> 0.05). It indicated that patients with DCM who has the presence of LGE had worse cardiac function and ventricular remodeling.(4)Compared of group A and group a, group A and group b, group a and group b, the differences of LVEDV, LVESV, LVEF, LVMM, FS, LVEDD and SI were considered statistically significant (P<0.05), but the differences of SV, CO and CI were considered no statistically significant (P>0.05). It indicated that the degree of impairment of cardiac function in patients with DCM was related to the presence and extent of myocardial fibrosis.Conclusions:(1)The more obvious dilatation of LV chamber, the worse cardiac function and the heavier myocardial mass, the higher the plasma NT-proBNP levels are. It demonstrated that the plasma NT-proBNP levels can reflect the severity of cardiac structure and function, and further reflect the severity of ventricular remodeling.(2)The presence and extent of myocardial fibrosis by LGE-CMR can reflect the severity of cardiac structure and function after ventricular remodeling in patients with DCM. The more number of involved cardiac segments, the worse cardiac function, the more serious the degree of ventricular remodeling, the higher the plasma NT-proBNP levels.(3)The detection of myocardial fibrosis by CMR can provide more valuable information for the evaluation and prognosis of DCM patients. |
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