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

赵亚男; 崔佳宁; 张兴华; 李金锋; 陈仕敏; 岳修正; 李涛

doi:10.24920/004120

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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

中国医学科学杂志（英文） 2023年38卷第1期页码：11-19

Original Article | Updated：2024-03-30

- 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
- Affiliations：
  
  1. 1Department of Radiology, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
  2. 2Department of Epidemiology and Statistics, Graduate School of Chinese People's Liberation Army General Hospital, Beijing 100853, China
  3. 3Philips Healthcare, Beijing 100600, China
- Author bio：
  
  李涛，电子邮件：litaofeivip@163.com
- Funds：
- DOI：10.24920/004120
  中图分类号：
- 收稿日期：2022-06-08，
  
  录用日期：2022-8-10，
  
  网络出版日期：2022-09-09，
  
  纸质出版日期：2023-03-31
- Accepted：
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赵亚男, 崔佳宁, 张兴华, 等. 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[J]. 中国医学科学杂志（英文）, 2023,38(1):11-19.

Ya-Nan Zhao, Jia-Ning Cui, Xing-Hua Zhang, et al. 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.
赵亚男, 崔佳宁, 张兴华, 等. 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[J]. 中国医学科学杂志（英文）, 2023,38(1):11-19. DOI： 10.24920/004120.

Ya-Nan Zhao, Jia-Ning Cui, Xing-Hua Zhang, et al. 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. DOI： 10.24920/004120.

摘要

目的

应用心脏磁共振特追踪技术（cardiac magnetic resonance feature-tracking，CMR-FT）探讨微血管阻塞（microvascular obstruction，MVO）对ST段抬高型心肌梗死（ST segment-elevation myocardial infarction，STEMI）患者整体和局部心功能的影响。

方法

回顾性连续纳入经皮冠状动脉介入术治疗成功后且1~7 天进行心脏磁共振（cardiac magnetic resonance，CMR）检查的急性STEMI 患者。依据延迟钆增强成像（late gadolinium enhancement，LGE）将患者分为MVO阳性组和MVO阴性组。参照左心室16节段模型，将左心室心肌分为梗死区、邻近区和遥远区。利用CMR-FT，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 strain，RS)、周向应变（circumferential strain，CS）及纵向应变（longitudinal strain，LS)，并且采用独立样本t检验比较MVO阳性和MVO阴性患者之间的差异。Logistic回归分析用于探究MVO与LV功能受损的关联。

结果

在157名STEMI患者（平均年龄 56.66 ± 11.38 岁）中，发现59例MVO阳性患者（37.58%），且MVO阳性组平均MVO面积为3.00±3.76mL。与MVO阴性患者（n=98）相比，MVO阳性患者LV整体RS（

= -4.30，P

0.001）、整体CS（

= 4.99，

0.001）、整体LS（t=3.51，P = 0.001）显著降低。MVO阳性患者梗死区RS（

= -3.38，

=0.001）和CS（

= 2.64，

=0.01）相较于MVO阴性的患者显著降低，梗死面积显著增大（

= 8.37，

0.001）。在单变量Logistic 回归分析中，发生LV MVO [OR= 4.10

95%CI：2.05~8.19，

0.001) 、MVO面积[OR=1.38

95%CI：1.10~1.72，

=0.01

]

、心率以及LV梗死面积与CS受损显著相关。然而，在多变量Logistic回归分析中只有心率（OR=1.08，95%CI：1.03~1.13，

=0.001）和LV梗死面积（O

R=1.10，95% CI：1.03~1.16，

=0.003）是LV整体CS受损的独立影响因素。

结论

MVO阳性的STEMI患者心肌梗死面积较大，并且MVO可使左心室整体和局部心功能恶化。

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

-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 (

=98 )

the MVO group had significantly reduced LV global RS (

= -4.30

0.001)

global CS (

= 4.99

0.001)

and global LS (

= 3.51

= 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (

= -3.

= 0.001;

= 2.64

= 0.01; respectively) and the infarct size was significantly larger (

= 8.37

0.001) than that of patients without MVO. The presence of LV MVO [

= 4.10

95%

: 2.05 - 8.19

0.001) and its size [

=1.38

95%

: 1.10-1.72

=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 (

=1.08

95%

: 1.03 - 1.13

=0.001) and LV infarct size (

=1.10

95%

: 1.03 - 1.16

=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.

关键词

Keywords

references

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