摘要
目的:探讨多模态心脏磁共振(CMR)成像参数对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后左心室功能恢复的预测价值。方法:前瞻性纳入2020年1月至2025年5月在荆门市中心医院接受急诊PCI的82例STEMI患者,依据左心室射血分数(LVEF)恢复情况将其分为LVEF恢复组(45例)和未恢复组(37例)。术后72 h及6个月行多模态CMR检查。通过多因素logistic回归筛选独立预测因子,采用受试者工作特征(ROC)曲线下面积(AUC)评估多模态CMR对左心室功能恢复的诊断效能,采用冠状动脉病变程度Syntax评分系统对比两组心肌应变参数整体纵向应变(GLS)、组织特征参数及功能指标。对比两组STEMI患者主要终点的LVEF提升幅度和舒张末期容积指数(EDVI)变化量指标,以及次要终点的纽约心脏协会(NYHA)分级、6 min步行距离(6MWD)和主要不良心血管事件(MACE)指标。结果:未恢复组心肌缺血时间为7.5 h,高于恢复组(4.2 h),差异有统计学意义(Z=-5.147,P<0.001);未恢复组糖尿病和多支病变比例分别为48.65%和35%,均高于恢复组,差异均有统计学意义(χ^(2)=4.147、4.427,P<0.05)。CMR参数显示,恢复组急性期GLS绝对值为(-12.54±2.326)%,高于未恢复组,微循环区T2值和LGE体积分别为(52.3±6.2)ms和(18.54±5.32)g,均低于未恢复组,差异均有统计学意义(t=7.215、-6.987、-5.874,P<0.001)。多因素分析筛选GLS、T2值、LGE体积及Syntax评分为独立预测因子(OR=2.10、0.81、0.83、0.86,P<0.05)。联合模型AUC为0.921(95%CI:0.865~0.977),显著优于单一参数。次要终点中,恢复组在NYHA分级改善≥1级、6MWD增加≥50 m的发生率均显著高于未恢复组,而MACE的发生率显著低于未恢复组,差异均有统计学意义(χ^(2)=37.215、42.326、10.547,P<0.001)。结论:基于GLS、T2值、LGE体积及Syntax评分系统的联合模型可有效预测STEMI患者左心室功能恢复,为个体化康复策略提供影像学依据。
Objective:To explore the predictive value of multimodal cardiac magnetic resonance(CMR)parameters for functional recovery of left ventricle in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergent surgery with percutaneous coronary intervention(PCI).Methods:A total of 82 STEMI patients underwent emergent PCI at Jingmen Central Hospital from January 2020 to May 2025 was prospectively enrolled.Participants were divided into a left ventricular ejection fraction(LVEF)recovery group(n=45)and a non-recovery group(n=37)based on LVEF recovery.Multimodal CMR examination was conducted at the 72th h and the 6th month after surgery.Multivariate logistic regression was used to screen independently predictors.The receiver operating characteristic(ROC)curve was adopted to assess the diagnostic performance of multimodal CMR for functional recovery of left ventricle.The SYNTAX score system about severity of coronary artery disease was adopted to compare the general longitudinal strain(GLS)of myocardial strain parameters,and parameters and functional indicators of tissues'characteristic between two groups.The increased amplitude of LVEF values,and the indicator of EDVI variation of STEMI patients between two groups were compared at main endpoint,as well as the grading of New York Heart Association(NYHA),6 minutes walking distance(6MWD)and major adverse cardiovascular events(MACE)of secondary endpoint.Results:Ischemic time was 7.5 hours in the non-recovery group,which was significantly higher than that in the LVEF recovery group(4.2 hours)(Z=-5.147,P<0.001).The non-recovery group exhibited higher proportions of diabetes(48.65%)and multi-vessel disease(35%),which were significantly higher than those of the LVEF recovery group(χ^(2)=4.147,4.427,P<0.05).CMR parameters revealed that the GLS absolute value in the LVEF recovery group was(-12.54±2.326)%at acute period,which was significantly higher than that in the non-recovery group.T2 value at the microcirculation zone and late gadolinium enhancement(LGE)volume were respectively(52.3±6.2)ms and(18.54±5.32)g,which were lower than those in the LVEF recovery group(t=7.215,-6.987,-5.874,P<0.001).Multi factors analysis identified GLS,T2 value,LGE volume,and Syntax score as independent predictors(OR=2.10,0.81,0.83,0.86,P<0.05).The area under curve(AUC)value of combined model was 0.921(95%CI:0.865-0.977),which was significantly better than that of single parameter.For secondary endpoints,the incidence rates that the improvement of NYHA grading was≥1 grade and the increase of 6 MWD was≥50 m in LVEF recovery group were significantly higher than those of non-recovery group,however,the incidence of MACE was significantly lower than that of non-recovery group,with significant differences(χ^(2)=37.215,42.326,10.547,P<0.001).Conclusion:The combined model based on GLS,T2 value,LGE volume and SYNTAX score system can effectively predict functional recovery of left ventricle in STEMI patients,which can provide imaging support for individual rehabilitation strategies.
作者
王辉
李文文
贺仁杰
黄茜
聂琳
Wang Hui;Li Wenwen;He Renjie;Huang Qian;Nie Lin(Department of Radiology,Jingmen Central Hospital and Jingmen Central Hospital Affiliated to Jingchu University of Technology,Jingmen 448000,China;Department of Clinical Nutrition,Jingmen Central Hospital and Jingmen Central Hospital Affiliated to Jingchu University of Technology,Jingmen 448000,China)
出处
《中国医学装备》
2025年第12期44-49,共6页
China Medical Equipment
基金
湖北省卫生健康委员会2023年度科研项目(HBJG-220015)。
