分子影像学杂志2023，Vol.46Issue(6)：1001-1008,8.DOI:10.12122/j.issn.1674-4500.2023.06.08
微循环障碍与急性心肌梗死患者梗死面积、心肌应变及临床预后的相关性分析
Correlation analysis of microcirculation disorders with infarct size,myocardial strain,and clinical prognosis in patients with acute myocardial infarction
摘要
Abstract
Objective To explore the correlation analysis between myocardial MRI assessment of microcirculation disorders(MVO),infarct size,myocardial strain and clinical prognosis in patients with acute myocardial infarction.Methods A total of 24 patients treated with percutaneous coronary intervention for ST segment elevation myocardial infarction(STEMI)at the First Affiliated Hospital of Bengbu Medical College from June 2022 to December 2022 were selected as the study subjects,including 22 male and 2 female patients,with an average age of 55.3±11.3 years old.All patients underwent cardiac magnetic resonance imaging 5-7 d after surgery.Based on the presence and absence of microcirculation disorders,the 24 patients were divided into MVO group(n=16)and non MVO group(n=8),then compared the baseline data,cardiac function,myocardial infarction area(LGE%)and myocardial strain between the two groups.The discharged STEMI patients were followed up for an average of 6 months in the outpatient clinic or by telephone to record the occurrence of adverse cardiovascular events(MACE events),and compare the differences in the MACE events between the two groups.The MACE events defined in this study include recurrent chest pain,heart failure,stroke,recurrent myocardial infarction,bleeding,revasc-ularization,in-stent thrombosis,in-stent restenosis and death.Results The radial strain,circumferential strain,and overall circumferential strain of the infarcted segment in the MVO group were lower than those in the non MVO group(P<0.05);The myocardial infarction area in the MVO group was larger than that in the non MVO group(25.18%±10.51%vs 9.93%±5.96%).The left ventricular ejection fraction in the MVO group was highly correlated with radial and circumferential strain[r=0.815(0.536-0.934),P<0.001;r=-0.938(-0.978—-0.852),P<0.001],and strongly correlated with longitudinal strain[r=-0.767(-0.915—-0.437),P<0.001].LGE%and circumferential strain of the infarcted segment in binary regression analysis are independent risk factors for MVO in STEMI patients.In univariate analysis,ROC curve showed that LGE%could assist in the diagnosis of MVO.The AUC was 0.922(0.796-1.000),with an optimal cutoff point of 14.92%,sensitivity of 87.5%and specificity of 87.5%(P<0.05).The circumferential strain of the infarcted segment also has diagnostic value for MVO,with an AUC of 0.781(0.591-0.971),an optimal cutoff point of 10.58%,sensitivity of 62.5%,and specificity of 87.5%(P<0.05).After LGE%was combined with the circumferential strain of the infarcted segment,its AUC and sensitivity for MVO diagnosis increased,with an AUC of 0.938(0.827-1.000),a sensitivity of 93.8%,and a specificity of 87.5%(P<0.05).MACE events occurred in a total of 10 STEMI patients followed up in the study,accounting for 41.7%of the total number.There was no statistically significant difference in the occurrence of MACEs events between the two groups of patients(P=0.558).Conclusion LGE%and circumferential strain of myocardial infarction segment are independent risk factors for MVO after percutaneous coronary intervention in STEMI patients,and they also have high diagnostic value for MVO.The combination of the two has higher diagnostic value for MVO.There is a strong correlation between radial strain,circumferential strain,and longitudinal strain and left ventricular ejection fraction in the MVO group.关键词
急性心肌梗死/微循环障碍/心肌梗死面积/心肌应变Key words
acute myocardial infarction/microcirculation disorders/myocardial infarction area/myocardial strain引用本文复制引用
丁丝雨,王洪巨,李妙男,丁斌,宋禧龙,李尧,牛奇林,宋宏伟,宣玲,史晓俊,高大胜..微循环障碍与急性心肌梗死患者梗死面积、心肌应变及临床预后的相关性分析[J].分子影像学杂志,2023,46(6):1001-1008,8.基金项目
国家自然科学基金(81970313) （81970313）
安徽省临床医学研究转化专项(202304295107020086) （202304295107020086）
安徽省教育厅自然科学研究重点项目(2022AH051477) （2022AH051477）
蚌埠医学院第一附属医院 2022 年度高新技术(2022050) （2022050）
蚌埠医学院512人才培育计划(by51201317、by51201105) （by51201317、by51201105）
安徽省高校重点研究项目(SK2021A0433)Supported by National Natural Science Foundation of China(81970313) （SK2021A0433）
