磁共振成像2025，Vol.16Issue(8)：65-72,8.DOI:10.12015/issn.1674-8034.2025.08.010
心电图Q波与CMR心肌应变对急性ST抬高型心肌梗死患者PCI治疗后微循环阻塞的预测价值
Predictive value of electrocardiographic Q waves and CMR myocardial strain for microcirculatory obstruction after PCI treatment in patients with acute ST-elevation myocardial infarction
摘要
Abstract
Objective:This study investigates the predictive value of cardiac magnetic resonance(CMR)myocardial strain,hospital admission electrocardiogram Q waves,and their combination for microvascular obstruction(MVO)following percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Materials and Methods:A retrospective analysis was conducted on the clinical and imaging data of 40 control cases and 133 acute STEMI patients who underwent direct PCI for the first time and underwent CMR examination 3 to 7 days post-treatment between September 2021 and September 2024.Acute STEMI patients were divided into the NQ group and Q group based on the presence or absence of pathological Q waves on the admission electrocardiogram,and a comparative analysis was performed to identify differences in clinical and imaging data between the two groups.Based on CMR examination results,acute STEMI patients were divided into MVO and non-MVO groups.Logistic regression analysis was used to assess the independent association of each parameter with MVO,and receiver operating characteristic(ROC)curves were plotted to evaluate predictive performance.A combined predictive model was established to analyse the predictive efficacy for MVO.Results:The acute STEMI group had significantly higher Q-wave width,Q-wave depth,total cholesterol,triglycerides,fasting blood glucose,glycated haemoglobin,preoperative troponin,preoperative creatine kinase,preoperative creatine kinase isoenzymes,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)were all higher than those in the control group,with statistically significant differences(P<0.05).In the acute STEMI group,left ventricular ejection fraction(LVEF),global circumferential strain(GCS),global radial strain on the short axis(GRSSAX),global radial strain on the long axis(GRSLAX),and global longitudinal strain(GLS)were all lower than those in the control group.In the Q group,the Q wave width at admission,Q wave depth at admission,preoperative troponin,preoperative creatine kinase,preoperative creatine kinase isoenzymes,infarct size(IS),transmural infarction patients,patients with MVO,the proportion of MVO in the left ventricular myocardium,and LVESV were all higher than those in the NQ group,with statistically significant differences(P<0.05).The Q group had lower LVEF,GCS,GRSSAX,GRSLAX,and GLS than the NQ group,with statistically significant differences(P<0.05).The Q wave depth at admission was significantly higher in the MVO group than in the non-MVO group(P<0.05).Logistic regression analysis showed that GLS,GCS,and GRSSAX were independent predictors of MVO(P<0.05).GLS,GCS,and GRSSAX were significantly reduced in the MVO group(P<0.05),with GRSSAX exhibiting the highest predictive efficacy for MVO,with an area under the curve of 0.791.The combination of admission Q-wave depth and GRSSAX demonstrated superior predictive performance for MVO compared to the use of admission Q-wave depth or CMR myocardial strain parameters alone,with an area under the curve of 0.824.Conclusions:The depth of the Q wave at admission and CMR myocardial strain parameters have predictive value for MVO after PCI in patients with acute STEMI.In addition,the combination of Q wave depth at admission and GRSSAX can further improve the accuracy of predicting the risk of MVO.关键词
ST段抬高型心肌梗死/心脏磁共振/心肌应变/病理性Q波/微血管阻塞Key words
ST-segment elevation myocardial infarction/cardiac magnetic resonance/myocardial strain/pathological Q-wave/microvascular obstruction分类
医药卫生引用本文复制引用
刘苏宁,叶文颖,张子倩,周莹..心电图Q波与CMR心肌应变对急性ST抬高型心肌梗死患者PCI治疗后微循环阻塞的预测价值[J].磁共振成像,2025,16(8):65-72,8.基金项目
SKY Imaging Research Fund of China Foundation for International Medical Exchange(No.Z-2014-07-2101) （No.Z-2014-07-2101）
Lianyungang City Health Planning Commission Surface Project(No.202007). 中华国际医学交流基金会SKY影像科研基金项目(编号:Z-2014-07-2101) （No.202007）
连云港市卫计委面上项目(编号:202007) （编号:202007）
