目的 探讨造影剂延迟增强心脏 磁共振成像(DE-CMR)在主动脉关闭不全 (AI)患者手术预后评估中的应用价值。方 法 回顾性分析行手术治疗的AI患者48例 病例资料，根据术前DE-CMR检查是否出 现钆对比延迟增强分为增强组和非增强 组，比较两组患者的资料特征，随访至 2017年3月记录不良预后发生情况，并分 析不良预后的预测因子。结果 48例患者 中，钆剂延迟增强患者17例(35.42%)，非 钆剂延迟增强患者31例(64.48%)；两组 患者性别、年龄、高血压、糖尿病、术 前心功能分级比较，差异无统计学意义 (P＞0.05)，增强组术前LVESD、LVEDD、 左心房前后径、左心室最大横径均大于 非增强组，(P＜0.05)，随访期间室性心 律失常、心功能进展为Ⅲ-Ⅳ级、死亡的 几率分别为 23.52%、 35.29%、29.41% 高于非增强组的3.23%、9.68%、6.45%(P ＜0.05)；Cox比例风险模型分析显示 LVEDD、LVESD、左心房前后径是AI术后不 良预后的独立预测因子。结论 DE-CMR诊 断AI可提供更加全面的影像学资料，其中 钆对比剂延迟增强识别的心肌纤维化可预 测不良预后。

Objective To investigate the application value of contrast delayed enhanced cardiac magnetic resonance imaging (DE-CMR) in evaluation of the prognosis of patients with aortic insufficiency (AI) after surgery. Methods The medical records of 48 patients with AI treated by surgery were retrospectively analyzed. According to the occurrence of gadolinium contrast delayed enhancement of DE-CMR before surgery, the patients were divided into the enhancement group and the non-enhancement group, and the data of the two groups were compared. All patients were followed up to March 2017, and the incidence of adverse prognosis was recorded and the predictors of adverse prognosis were analyzed. Results Of the 48 patients, 17 patients had delayed gadolinium enhancement (35.42%) and 31 patients did not have (64.48%). There were no significant differences between the two groups in gender, age, hypertension, diabetes and grade of cardiac function before surgery (P>0.05). Before surgery, the LVESD, LVEDD, left atrial anteroposterior diameter and the maximum left ventricular diameter of the enhancement group were greater than those of the non-enhancement group (P<0.05). During the follow-up, the probabilities of ventricular arrhythmia, heart function, cardiac function progressing to grade III-IV and death rates in the enhancement group (23.52%, 35.29%, 29.41%) were higher than those in the non-enhancement group (3.23%, 9.68%, 6.45%) (P<0.05). Cox proportional hazards model analysis showed that LVEDD, LVESD, left atrial anteroposterior diameter were independent predictors of adverse prognosis after AI surgery. Conclusion DE-CMR can provide more comprehensive imaging data for diagnosis of AI, and myocardial fibrosis identified by gadolinium delayed enhancement can predict the adverse prognosis.