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目的 探讨直背综合征(SBS)患者心脏磁共振成像(CMR)所示心脏压迫部位与特发性心律失常发生的关系.方法 回顾性入选北京安贞医院2015年4月至2016年3月接受CMR检查的患者1 432例,以胸8椎体水平胸腔前后径/横径(APD/TTD)比值＜0.37为标准筛选出扁平胸患者76例,排除合并冠心病、心肌病、先天性心脏病、缺血性心脏病、心肌炎、瓣膜病等器质性心脏病患者33例,最终人选43例直背综合征(SBS)患者,然后根据CMR有无心脏形态学改变分为单纯SBS组(19例)和SBS伴心脏形态异常组(24例).收集所有入选者的病历资料、心电图资料、电生理检查及相关手术记录.收集两组患者CMR图像,观察胸廓形态改变导致的心脏形态结构改变,并对CMR与心电图及电生理的检查结果进行对照分析,分析心脏压迫部位与心律失常类型及其起源部位的关系.结果 最终人选的43例SBS患者中男性21例,女性22例,年龄13 ～58(28.5±11.5)岁.CMR所示单纯SBS组和SBS伴心脏形态异常组患者APD/TTD比值分别为0.30±0.03和0.29 ±0.04,差异无统计学意义(P＞0.05);单纯SBS组患者左心室射血分数(LVEF)虽高于SBS伴心脏形态异常组[(59.31±9.04)％比(47.48±12.77)％],但差异无统计学意义(P＞0.05).SBS伴心脏形态异常组患者多平面电影图像可见右心室及左心房直接受压征象,右心室受压表现为心前脂肪间隙消失,右心室前游离壁及部分右心室流出道紧贴胸廓前壁,胸腔前后径缩短,横径增加,部分患者可见右心房扩大及三尖瓣反流等继发征象;左心房受压表现为轴位像左心房扁平,左心房前后径缩短,横径径增加,部分患者可见左心室扩大及二尖瓣反流;另有2例患者分别出现室壁运动不协调和心肌纤维化的CMR征象.单纯SBS组的19例患者中,CMR所示心脏受压部位与心电图及电生理检查结果提示的心脏搏动异位起源部符合者8例(42.1)％,不符合者6例(31.6％),未评估者5例(26.3％).SBS伴心脏形态异常组24例患者中,CMR所示心脏受压部位与心律失常起源部位符合者13例(54.2％),不符合者7例(29.2％),未评估者4例(16.7％).SBS伴心脏形态异常组的符合率高于单纯SBS组,但差异无统计学意义(P＞0.05).结论 SBS患者CMR所示心脏压迫部位与特发性心律失常发生具有一定的关联,其可能为心律失常发生的原因之一.

Objective To retrospectively analyze the potential correlation between cardiac magnetic resonance (CMR) imaging and clinical features and idiopathic arrhythmia in patients with straight back syndrome (SBS).Methods Patients receiving CMR imaging examination from April 2015 to March 2016 at our department (n =1 432) were screened,76 patients met the diagnosis criteria of flat chest (anteroposterior diameter/transthoracic diameter (APD/TTD) ratio ＜ 0.37 at the T8 vertebra).After excluding 33 patients with structural heart disease,43 SBS patients were divided into two groups:SBS without obvious morphological change in the heart (group A,n =19) and SBS with morphological change of the heart (group B,n =24).CMR images were analyzed,focusing the heart morphological changes induced by SBS.The clinical data were collected to comprehensively analyze the medical history,electrocardiogram and electrophysiological examination in order to observe the relationship between SBS induced heart morphological change and the arrhythmia type and origin.Results There were 21 male patients in this cohort,mean age was (28.5 ± 11.5) years (13-58 years).APD/TTD ratio was similar between the two groups (0.30 ± 0.03 vs.0.29 ± 0.04,P ＞ 0.05).LVEF tended to be lower in group B than in group A ((47.48±12.77)％vs.(59.31 ±9.04)％,P＞0.05).In group B,there were 15 patients with left ventricular enlargement,2 with left ventricular wall thickening,5 with uncoordinated ventricular wall motion,5 with tricuspid regurgitation,3 with mitral regurgitation,2 with myocardial fibrosis,5 with increased trabecular and 16 with decreased left ventricular function.Direct compression sign of right ventricle (disappeared precordial fat tissue space,secondary right atria enlargement and tricuspid regurgitation) and left atria (with or without secondary left ventricular enlargement and mitral regurgitation) were evidenced in patients of group B.CMR revealed that the arrhythmia origin corresponded the compression site of the heart in 8 cases (42.1％) in group A and 13 cases (54.2％) in group B,not corresponded to the compression site in 6 patients (31.6％) in group A and in 7 patients (29.2％) in group B,not attributable in 5 patients (26.3％) in group A and 4 patients (16.7％) in group B.The percent of arrhythmia origin corresponded the compression site of the heart tended to be higher in group B as compared to group A (P ＞ 0.05).Conclusion SBS can induce changes of cardiac morphology and cardiac function.SBS induced cardiac compression is linked with the development of arrhythmias and might be one of the reasons of arrhythmias in these patients.