Chinese Medical Sciences Journaldoi: 10.24920/004120

• 研究论文 •    下一篇

ST段抬高型心肌梗死患者微血管阻塞与心脏磁共振测定的整体和区域心肌功能的关系

赵亚男1,崔佳宁1,张兴华1,李金锋1,陈仕敏2,岳修正3,李涛1*   

  1. 1中国人民解放军总医院第一医学中心放射诊断科,北京,100853

    2中国人民解放军总医院研究生院流行病与统计学教研室,北京,100853 3飞利浦健康科技,北京,100600

  • 收稿日期:2022-06-08 接受日期:2022-08-10 发布日期:2022-09-09
  • 通讯作者: 李涛, E-mail: litaofeivip@163.com

Relationship Between Microvascular Obstruction and Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment-Elevation Myocardial Infarction

Yanan Zhao1, Jianing Cui1, Xinghua Zhang1,Jinfeng Li1, Shimin Chen2, Xiuzheng Yue3, Tao Li1*   

  1. 1Department of Radiology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing 100853, China

    2Department of Epidemiology and Statistics, The graduate school of Chinese People’s Liberation Army General Hospital, Beijing 100853, China 3Philips Healthcare, Beijing 100600, China

  • Received:2022-06-08 Accepted:2022-08-10 Online:2022-09-09
  • Contact: Tao Li,M.D., E-mail: litaofeivip@163.com

摘要:

目的:应用心脏磁共振特征追踪技术(cardiac magnetic resonance feature-trackingCMR-FT)研究ST段抬高型心肌梗死(ST-segment-elevation myocardial infarctionSTEMI)患者在经皮冠状动脉介入治疗后微血管阻塞(microvascular obstructionMVO)对患者整体和区域心功能的影响。

方法:回顾性收集STEMI患者的临床资料。所有患者在罪犯血管再通成功后17天行心脏磁共振检查。依据延迟钆增强成像结果将患者分为MVO阳性组和MVO阴性组。参照左室16节段模型,依据延迟钆增强成像结果将左心室心肌分为梗死区、邻近区和遥远区。采用心脏磁共振特征追踪技术,在电影图像上分别测量左心室整体以及梗死区、邻近区和遥远区的径向应变(radial strainRS)、周向应变(circumferential strainCS)及纵向应变(longitudinal strainLS)。采用独立样本t检验比较MVO阳性患者和MVO阴性患者左心室整体及区域应变。采用Logistic回归分析MVO对左心功能的影响。

结果:157STEMI患者中, 59例(37.58%)为MVO阳性, MVO阳性组平均MVO大小为3.00 ± 3.76 mlMVO阳性组左心室整体RS(20.25% ± 4.75% 24.14% ± 5.96%, t = -4.30, P < 0.001)CS(-12.85% ± 2.52% -14.99% ± 2.66%, t = 4.99, P < 0.001)LS(-10.80% ± 3.39%-12.64% ± 3.03%, t = 3.51, P = 0.001)均显著低于MVO阴性组。此外,MVO阳性组梗死区的RS (12.05% ± 5.83% 15.92% ± 8.42%, t = -3.38, P = 0.001)CS(-8.53% ± 4.83%-10.87% ± 5.70%, t = 2.64, P = 0.01)MVO阴性组明显受损,而MVO阳性患者心肌梗死范围(36.55±16.55 ml17.97±11.23 mlt = 8.37P < 0.001)明显大于MVO阴性患者。单因素Logistic回归分析显示:发生左心室MVO[OR 4.10 (95%CI 2.05-8.19)]和左心室MVO的大小[OR 1.38(95%CI 1.10-1.72)]与左心室整体CS受损显著相关。

结论: MVO阳性的STEMI患者心肌梗死范围较大,并且MVO可使左心室整体和区域心功能恶化。

关键词: 心脏磁共振特征追踪技术, ST段抬高型心肌梗死, 微血管阻塞, 心肌应变

Abstract:


Objective: To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.

Methods: Acute STEMI patients who underwent cardiac magnetic resonance at 1-7 days after successfully reperfusion were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, the STEMI patients were divided into the group with MVO and without MVO. The infarct zone, adjacent zone and remote zone were determined based on a myocardial 16-segment model on late gadolinium enhancement images. The radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) of the global left ventricle and infarct, adjacent and remote zone strains were measured by CMR-FT from cine images. The global and regional strains in patients with and without MVO were compared using independent-samples t-test. Logistic regression analysis was used to assay the association of MVO with the reduced left ventricular function.

Results: A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled in the study. The MVO was detected in 59 of 157 (37.58%) STEMI patients and MVO mean size was 3.00 ± 3.76 ml. STEMI patients with MVO had reduced global RS (20.25% ± 4.75% vs. 24.14% ± 5.96%, t = -4.30, P < 0.001), global CS (-12.85% ± 2.52% vs. -14.99% ± 2.66%, t = 4.99, P < 0.001) and global LS (-10.80% ± 3.39% vs. -12.64% ± 3.03%, t = 3.51, P = 0.001) than those without MVO. In addition, RS (12.05% ± 5.83% vs. 15.92% ± 8.42%, t = -3.38, P = 0.001) and CS (-8.53% ± 4.83 % vs. -10.87% ± 5.70%, t = 2.64, P = 0.01) in infarct zone were significantly diminished and the infarct size (36.55 ± 16.55 ml vs. 17.97 ± 11.23 ml, t = 8.37, P < 0.001) was larger in patients with MVO, compared with patients without MVO. In univariable logistic regression analysis, the presence of left ventricular MVO [OR 4.10 (95%CI 2.05-8.19)] and left ventricular MVO size [OR 1.38 (95%CI 1.10-1.72)] were significantly associated with reduced left ventricular global CS.

Conclusion: The infarct size was larger in STEMI patients with MVO and MVO deteriorates the global and regional myocardial function of left ventricle.

Key words: cardiac magnetic resonance feature-tracking, ST-segment-elevation myocardial infarction; microvascular obstruction, myocardial strain

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