摘要
目的:探讨心脏核磁共振(CMR)特征追踪(FTI)、首过灌注成像(PFI)、延迟钆强化技术(LGE)获得的参数对于预测ST段抬高型心肌梗死(STEMI)患者急诊血运重建后心功能改善的价值。方法:连续入选2018年1月至2020年1月行急诊经皮冠状动脉介入术(PCI)的初次诊断STEMI患者58例,术后即刻超声心动图检查提示左室射血分数(LVEF)≤40%,在成功实施血运重建后3~5 d行CMR检查。先后应用SSFP电影序列、T2W STIR-FSE序列、LGE进行扫描并分别获取FTI、PFI及LGE图像,利用后处理分析软件分别计算左室整体收缩期峰值圆周应变(GCS)和纵向应变(GLS)、心肌挽救指数(MSI),并在12个月后复查超声心动图。结果:12个月随访发现27例(47%)心功能改善(LVEF增加≥5%)。GCS判断患者心功能改善的临界值为-19.1%,敏感性为76%、特异性为85%[曲线下面积(AUC)=0.86,95%CI:0.71~0.92,P<0.001],优于GLS(ΔAUC=0.14,P=0.01)。MSI的临界值为61.5%,其敏感性为85%、特异性为91%,均优于GCS(ΔAUC=0.07,P<0.05)。多元回归分析显示,GCS和MSI是预测心功能改善的独立影响因素(HR=1.5,95%CI:1.0~1.9和HR=1.4,95%CI:1.1~1.7,P均<0.05)。结论:FTI技术估测的GCS在无需额外注射钆造影剂的情况下能预测STEMI患者PCI术后心功能改善,但MSI的诊断效能更高。
Objective:To investigate the predictive value of different parameters concerned with improving emeryency revascularization acquired by cardiac magnetic resonance(CMR),including feature tracking(FTI)first pass perfusion imaging(PFI)and delayed gadolinium enhancement(LGE)in patients with ST segment elevation myocardial infarction(STEMI).Methods:A total of 58 patients with STEMI underwent primary percutaneous coronary intervention(PCI)from January 2018 to January 2020,with left ventricular ejection fraction(LVEF)less than 40%tested by transthoracic echocardiography(TTE)immediately after PCI,were consecutively enrolled in this study.CMR was performed 3-5 days after successful revascularization.We used SSFP cine sequence,T2W STIR-FSE sequence and LGE sequence to acquire FTI,PFI and LGE images,respectively.The global systolic peak circumferential strain(GCS),longitudinal strain(GLS)and myocardial salvage index(MSI)were calculated by post-processing analysis software.After 12-month follow-up,TTE was reexamined.Results:After 12-month follow-up,27 patients(47%)showed improvement in cardiac function(LVEF increase≥5%).The cut-off value of GCS was-19.1%for evaluating the improvement of cardiac function(AUC=0.86,95%CI 0.71-0.92,P<0.001).The sensitivity and specificity of GCS were 76%and 85%,which were better than GLS(ΔAUC=0.14,P=0.01).The cut-off value of MSI was 61.5%.The sensitivity and specificity of MSI were 85%and 91%respectively,which were better than GCS(ΔAUC=0.07,P<0.05).Multiple regression analysis showed that GCS and MSI were independent predictors of cardiac function recovery(HR=1.5,95%CI 1.0-1.9;HR=1.4,95%CI 1.1-1.7,both P<0.05).Conclusions:GCS derived from FTI can predict cardiac function recovery in STEMI patients after PCI without additional gadolinium injection,but MSI is the most effective parameter.
作者
刘丹
顾佳宁
韩凯月
邸若岷
杨晨曦
杨奕清
徐迎佳
LIU Dan;GU Jianing;HAN Kaiyue;DI Ruomin;YANG Chenxi;YANG Yiqing;XU Yingjia(Department of Cardiology,Shanghai Fifth People′s Hospital,Fudan University,Shanghai 200040,China)
出处
《国际心血管病杂志》
2021年第3期184-188,共5页
International Journal of Cardiovascular Disease
基金
上海市卫生健康委员会(201740064)。
关键词
急性心肌梗死
经皮冠状动脉介入术
心脏核磁共振
心功能恢复
Acute myocardial infarction
Percutaneous coronary intervention
Cardiac magnetic resonance
Cardiac function recovery
