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局部心肌功能的关系

doi:10.24920/004120

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 Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.

Results A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n =98 ), the MVO group had significantly reduced LV global RS (t= -4.30, P < 0.001), global CS (t= 4.99, P < 0.001), and global LS ( t= 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t= -3.38, P = 0.001; t= 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t= 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR= 4.10, 95%CI: 2.05 - 8.19, P<0.001) and its size [OR=1.38, 95%CI: 1.10-1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 - 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.

Conclusion The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.

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

Ya-Nan Zhao, Jia-Ning Cui, Xing-Hua Zhang, Jin-Feng Li, Shi-Min Chen, Xiu-Zheng Yue, Tao Li. Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction[J].Chinese Medical Sciences Journal, 2023, 38(1): 11-19.

Figures/Tables 6

Figure 1.

Figure 2.

Figure 3.

Table 1.

Baseline characteristics of the STEMI patients with and without microvascular obstruction (n = 157)"

Items	All patients (n = 157)	Patient with MVO (n = 59)	Patient without MVO (n = 98)	P value
Demographic characteristics
Age (yrs, mean ± SD)	56.66 ± 11.38	54.12 ± 11.63	58.18 ± 11.01	0.03
Gender [male n (%)]	136 (86.6)	53 (89.8)	83 (84.7)	0.36
Body mass index [kg/m², mean ± SD]	25.68 ± 3.43	25.76 ± 3.20	25.63 ± 3.57	0.49
Clinical parameters
Family history of CAD [n (%)]	15 (9.6)	5 (8.5)	10 (10.2)	0.72
Hypertension [n (%)]	79 (50.3)	28 (47.5)	51 (52.0)	0.58
Hypercholesterolemia [n (%)]	33 (21.0)	17 (28.8)	16 (16.3)	0.63
Diabetes mellitus [n (%)]	23 (14.6)	11 (18.6)	12 (12.2)	0.27
Smoking [n (%)]	103 (65.6)	42 (71.2)	61 (62.2)	0.25
Drinking [n (%)]	37 (23.6)	13 (22.0)	24 (24.5)	0.73
Heart rate (beats/min, mean ± SD)	71.29 ± 11.61	73.59 ± 11.97	69.91 ± 11.22	0.054
Killip class >Ⅰ [n (%)]	16 (10.2)	7 (11.9)	9 (9.2)	0.59
Multivessel disease [n (%)]	101 (64.3)	36 (60.1)	65 (66.3)	0.501
Infarct related artery [n (%)]				0.52
Left anterior descending artery	69 (43.94)	28 (47.46)	41 (41.84)
Right coronary artery	70 (44.59)	22 (37.29)	48 (48.98)
Left circumflex artery	18 (11.46)	6 (10.17)	12 (12.24)
TIMI flow pre PCI < 3 [n (%)]	148 (94.3)	58 (98.3)	90 (91.8)	0.06
TIMI flow post PCI < 3 [n (%)]	2 (1.3)	1 (1.7)	1 (1.0)	0.72
Blood test results
NT-proBNP (pg/mL, mean ± SD)	1,616.01 ± 1,552.90	1,838.72 ± 2,118.44	1,481.92 ± 1,070.77	0.23
Maximum CK-MB (U/L, mean ± SD)	233.28 ± 163.89	317.34 ± 173.51	182.67 ± 135.31	<0.001
Peak troponin (mg/L, mean ± SD)	7.85 ± 7.84	12.65 ± 9.13	4.95 ± 5.15	<0.001
Medication [n (%)]
Aspirin	156 (99.4)	58 (98.3)	98 (100)	0.16
Statin	156 (99.4)	59 (100)	97 (99.0)	0.33
ACEI/ARB	70 (44.6)	21 (35.6)	49 (50.0)	0.08
Beta-blockers	135 (86.0)	50 (84.7)	85 (86.7)	0.73
Diuretic	76 (48.4)	31 (52.5)	45 (45.9)	0.42

Table 1.

Table 2.

Table 3.

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Items	All Patients (n = 157)	Patient with MVO (n = 59)	Patient without MVO (n = 98)	t value	P value^*
LV EDVI (mL/m²)	80.81 ± 18.94	83.31 ± 16.07	79.30 ± 20.40	1.29	0.20
LV ESVI (mL/m²)	43.44 ± 13.40	47.39 ± 13.04	41.06 ± 13.11	2.94	0.004
LV myocardial mass index (g/m²)	59.83 ± 11.61	62.24 ± 9.42	58.37 ± 12.58	2.04	0.04
LV infarct size (mL)	24.96 ± 16.18	36.55 ± 16.55	17.97 ± 11.23	8.37	<0.001
LVEF (%)	46.14 ± 9.23	43.01 ± 9.45	48.02 ± 8.61	-3.41	0.001
LV global WTR (%)	44.25 ± 13.64	40.21 ± 11.62	46.68 ± 14.23	-2.95	0.004
LV GRS (%)	22.70 ± 5.84	20.25 ± 4.75	24.17 ± 5.96	-4.30	<0.001
LV GCS (%)	-14.19 ± 2.80	-12.85 ± 2.52	-14.99 ± 2.66	4.99	<0.001
LV GLS (%)	-11.95 ± 3.28	-10.80 ± 3.39	-12.64 ± 3.03	3.51	0.001
Infarct zone RS (%)	14.46 ± 7.77	12.05 ± 5.83	15.92 ± 8.42	-3.38	0.001
Infarct zone CS (%)	-9.99 ± 5.49	-8.53 ± 4.83	-10.87 ± 5.70	2.64	0.01
Infarct zone LS (%)	-7.34 ± 4.48	-7.13 ± 3.65	-7.47 ± 4.93	0.46	0.65
Adjacent zone RS (%)	22.52 ± 7.59	22.90 ± 7.07	22.29 ± 7.92	0.49	0.63
Adjacent zone CS (%)	-14.71 ± 3.93	-14.42 ± 3.48	-14.89 ± 4.18	0.73	0.47
Adjacent zone LS (%)	-7.25 ± 4.18	-6.50 ± 3.46	-7.69 ± 4.51	1.75	0.08
Remote zone RS (%)	30.31 ± 9.85	31.94 ± 9.84	29.33 ± 9.78	1.62	0.11
Remote zone CS (%)	-17.30 ± 4.39	-17.20 ± 3.99	-17.36 ± 4.63	0.22	0.83
Remote zone LS (%)	-5.15 ± 9.67	-3.60 ± 8.98	-6.09 ± 9.99	1.57	0.12

Items	Univariate Logistic regression		Multivariate Logistic regression
Items	P value	OR [95%CI]	P value	OR [95%CI]
Age (yrs)	0.81	1.00 (0.97 - 1.03)
Gender (Male)	0.06	2.65 (0.97 - 7.24)
Body mass index (kg/m²)	0.27	1.05 (0.96 - 1.16)
Family history of CAD	0.15	2.30 (0.75 - 7.08)
Hypertension	0.23	1.47 (0.78 - 2.76)
Hypercholesterolemia	0.25	0.63 (0.29 - 1.38)
Diabetes mellitus	0.70	1.19 (0.49 - 2.89)
Smoking	0.09	1.80 (0.92 - 3.52)
Drinking	0.06	2.08 (0.98 - 4.42)
Killip class >Ⅰ	0.24	1.89 (0.65 - 5.49)
Heart rate	0.001	1.06 (1.02 - 1.09)	0.001	1.08 (1.03 - 1.13)
Culprit lesion in the LAD (%)	<0.001	3.25 (1.69 - 6.27)
NT-proBNP (pg/mL)	0.01	1.00 (1.00 - 1.00)
Maximum CK-MB (U/L)	<0.001	1.01 (1.00 - 1.01)
Peak troponin (mg/L)	<0.001	1.12 (1.06 - 1.20)
LV EDVI	0.35	1.01 (0.99 - 1.03)
LV ESVI	<0.001	1.08 (1.05 - 1.12)
LV myocardial mass index (g/m²)	<0.001	1.08 (1.04 - 1.12)
LV infarct size (mL)	<0.001	1.11 (1.07 - 1.15)	0.003	1.10 (1.03 - 1.16)
Presence of LV MVO (%)	<0.001	4.10 (2.05 - 8.19)
LV MVO size (mL)	0.01	1.38 (1.10 - 1.72)

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