急性ST段抬高型心肌梗死患者的梗死范围、心脏磁共振特征跟踪应变分析的区域心肌功能与梗死位置的关系

doi:10.24920/004060

摘要/Abstract

摘要：

目的定量评估初次接受经皮冠状动脉介入治疗的ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者的梗死范围、心脏磁共振特征跟踪（cardiac magnetic resonance feature tracking，CMR-FT）应变分析的区域心肌功能与梗死位置的关系。
方法本研究选取在我院进行再灌注治疗的STEMI患者，共纳入95例连续治疗成功的患者。我们对患者的心脏磁共振图像进行回顾性分析，并将患者分为前壁心肌梗死（anterior wall myocardial infarction，AWMI）和非前壁心肌梗死（nonanterior wall myocardial infarction，NAWMI）两组。我们采用晚期钆增强图像评估梗死特征；采用基于标准cine图像的CMR-FT技术评估整体和区域径向、周向和纵向应变及应变率。用Spearman或Pearson方法评估STEMI患者的梗死范围大小、CMR-FT应变分析的区域心肌功能与梗死位置的关系。
结果纳入AWMI患者44例，NAWMI患者51例。与NAWMI组相比，AWMI组患者的左心室强化程度明显更高（27.47±11.89比21.06±12.08 ％LV；t = 3.928，P = 0.008）。对梗死区的分析显示：与NAWMI组相比，AWMI组的径向、周向和纵向应变明显下降（Z =-20.873，-20.918，-10.357，P均 < 0.001）。在AWMI组中，左心室的容积（收缩末期容积指数）、总强化质量和强化质量的范围与梗死区应变的相关性最好（P均 < 0.001）。
结论在经皮冠状动脉介入治疗的STEMI患者中，与NAWMI患者相比，AWMI患者的心肌损伤范围更广泛，梗死区的心肌功能更低。

关键词: 心血管磁共振, 急性心肌梗死, 左心室, 组织追踪, 心肌应变

Abstract:

Objective To quantitatively evaluate the associations of infarct size, regional myocardial function examined by cardiac magnetic resonance feature tracking (CMR-FT) strain analysis with infarct location in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention.
Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion. The patients were divided into the anterior wall myocardial infarction (AWMI) and nonanterior wall myocardial infarction (NAWMI) groups. Infarct characteristics were assessed by late gadolinium enhancement. Global and regional strains and associated strain rates in the radial, circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images. The associations of infarct size, regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.
Results There were 44 patients in the AWMI group and 51 in the NAWMI group. The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group (24.47±11.89, 21.06±12.08 %LV; t=3.928, P = 0.008). In infarct zone analysis, strains in the radial, circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group (z=-20.873, -20.918, -10.357, all P < 0.001). The volume (end-systolic volume index), total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group (all P < 0.001).
Conclusion In STEMI patients treated by percutaneous coronary intervention, myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

Key words: cardiac magnetic resonance, acute myocardial infarction, left ventricular, tissue tracking, myocardial strain

Jianing Cui, Yanan Zhao, Wei Wang, Tao Li. Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction[J].Chinese Medical Sciences Journal, 2022, 37(4): 309-319.

图/表 12

参考文献 31

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Characteristic	Results
Age (yrs, mean ± SD)	54.73 ± 10.74
Sex [male, n (%)]	83 (87.4)
Height [cm, median (IQR)]	170 (168, 175)
Weight [kg, median (IQR)]	76 (70, 85)
Body mass index (kg/m², mean ± SD)	1.91 ± 0.18
Risk factors [n (%)]
Smoking	70 (73.7)
Family history of CAD	9 (9.5)
Hypertension	54 (56.8)
Diabetes mellitus	17 (17.9)
Hypercholesterolemia	28 (29.5)
Time interval CMR after PCI [d, mean ± SD]	5.90 ± 2.75
No. of vessels diseased [n (%)]
1	28 (29.5)
2	38 (40.0)
3	29 (30.5)
Infarct related artery [n (%)]
LAD	44 (46.3)
LCX	9 (9.5)
RCA	42 (44.2)

Items	AWMI (n = 44)	NAWMI (n = 51)	t/Z	P value
EDVI [ml/m², median (IQR)]	69.13 (62.25, 86.76)	74.96 (61.61, 87.96)	-0.735	0.462
ESVI [ml/m², median (IQR)]	37.44 (31.41, 50.64)	35.28 (29.38, 46.64)	-0.623	0.533
SVI [ml/m², median (IQR)]	35.86 (27.16, 43.12)	41.33 (31.47, 46.60)	-1.638	0.101
EF [%, median (IQR)]	47.31 (41.17, 52.44)	51.99 (37.48, 55.57)	-1.317	0.188
CO [L/min, median (IQR)]	5.02 (4.44, 5.90)	5.29 (4.73, 6.37)	-1.482	0.138
CI [L/min·m², median (IQR)]	2.72 (2.37, 3.30)	2.77 (2.52, 3.40)	-1.015	0.310
HR [beat/min, median (IQR)]	71.10 (62.45, 80.95)	65.50 (58.00, 75.40)	-1.549	0.121
Myocardial volume [ml, median (IQR)]	94.10 (15.50, 123.60)	92.98 (75.27, 121.40)	-0.037	0.970
Myocardial mass [g, median (IQR)]	113.82 (26.88, 134.76)	96.22 (19.12, 127.90)	-0.761	0.446
Extent of enhanced mass (%LV, mean ± SD)	27.47 ± 11.89	21.06 ± 12.08	3.928	0.008
Total enhanced volume [ml, median (IQR)]	25.37 (12.98, 38.33)	15.25 (8.27, 27.92)	-1.918	0.055
Total enhanced mass (g, mean ± SD)	30.46 ± 18.11	24.07 ± 16.58	3.784	0.056
MVO volume [ml, median (IQR)]	2.48 (1.55, 5.35)	1.72 (0.92, 3.98)	-1.614	0.106
MVO mass [g, median (IQR)]	2.80 (1.62, 5.38)	1.81 (0.96, 4.18)	-1.560	0.119

Groups	No. of segments	Peak strain [median (IQR)]			Peak systolic strain rate [median (IQR)]			Peak diastolic strain rate [median (IQR)]
Groups	No. of segments	Radial (%)	Circumferential (%)	Longitudinal (%)	Radial (%/s)	Circumferential(%/s)	Longitudinal (%/s)	Radial (%/s)	Circumferential (%/s)	Longitudinal (%/s)
Infarct segment	490	12.96 (8.30, 18.95)	-9.97 (-13.26, -6.36)	-9.04 (-14.71, -4.01)	0.83 (0.47, 1.27)	-0.69 (-0.96, -0.37)	-0.79 (-1.29, 0.62)	-0.88 (-1.33, 0.29)	0.64 (-0.26, 0.93)	0.78 (-0.33, 1.16)
Remote segment	1,030	28.45 (19.57, 38.09)	-17.48 (-21.01, -13.54)	-13.99 (-18.55, -8.95)	1.72 (1.22, 2.29)	-1.08 (-1.32, -0.85)	-1.13 (-1.54, -0.73)	-1.68 (-2.52, -1.09)	1.00 (0.75, 1.29)	0.96 (0.61, 1.36)
t/Z value		-20.873	-20.918	-10.357	-19.067	-16.586	-7.825	-16.731	-15.100	-5.454
P value		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Groups		n	Peak strain [median (IQR)]			Peak systolic strain rate [median (IQR)]			Peak diastolic strain rate [median (IQR)]
Groups		n	Radial (%)	Circumferential (%)	Longitudinal (%)	Radial (%/s)	Circumferential(%/s)	Longitudinal (%/s)	Radial (%/s)	Circumferential (%/s)	Longitudinal (%/s)
Global	AWMI	44 patients	18.78 (15.97, 22.32)	-12.80±3.47*	-9.87 (-12.02, -8.20)	0.98 (0.89,1.30)	-0.72 (-0.83,-0.62)	-0.60 (-0.70, -0.49)	-0.94 (-1.18,-0.64)	0.65 (0.50,0.75)	0.53 (0.45, 0.67)
	NAWMI	51 patients	22.84 (18.17,26.63)	-14.36±3.14*	-12.50 (-13.45, -10.56)	1.16 (0.89,1.48)	-0.78 (-0.88,-0.62)	-0.72 (-0.82, -0.61)	-0.98 (-1.40,-0.77)	0.64 (0.54,0.82)	0.62 (0.52, 0.76)
	t/Z value		-2.575	0.001	-4.146	-1.280	-0.702	-3.181	-1.709	-1.112	-2.580
	P value		0.010	0.025	<0.001	0.200	0.483	0.001	0.087	0.266	0.010
Infarct zone	AWMI	258 segments	12.49 (7.32,18.03)	-9.54 (-12.70,-5.72)	-6.95 (-12.10,3.22)	0.81 (0.34,1.21)	-0.67 (-0.98,0.27)	-0.62 (-1.13,0.63)	-0.81 (-1.26,0.58)	0.64 (-0.50,0.91)	0.63 (-0.51,0.97)
	NAWMI	232 segments	13.82 (8.77,20.63)	-10.24 (-14.00, -7.17)	-11.68 (-16.10, -6.54)	0.89 (0.53,1.30)	-0.71 (-0.93,-0.43)	-0.98 (-1.44,0.53)	-0.93 (-1.47,-0.47)	0.64 (0.38,0.97)	0.95 (0.51,1.31)
	t/Z value		-2.139	-2.086	-6.785	-1.909	-1.038	-3.634	-2.606	-1.824	-4.950
	P value		0.032	0.037	<0.001	0.056	0.299	<0.001	0.009	0.068	<0.001

Items	ICC	95%CI
Global
Radial	0.829	0.560-0.939
Circumferential	0.859	0.629-0.951
Longitudinal	0.780	0.475-0.920
Infarct zone
Radial	0.876	0.678-0.956
Circumferential	0.870	0.666-0.954
Longitudinal	0.899	0.728-0.965

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