延迟增强磁共振显像对冠状动脉旁路移植术后心功能改善的预测价值  

Predictive Value of Delayed-enhancement Magnetic Resonance Imaging for Measuring the Improvement of Cardiac Function in Patients With Coronary Artery Bypass Grafting

作　　者：杨滔[1] 陆敏杰[2] 孙寒松[1] 唐跃[1] 潘世伟[1] 赵世华[2] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院成人心脏外科中心,北京市100037 [2]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院,北京市100037

出　　处：《中国循环杂志》2014年第2期115-119,共5页Chinese Circulation Journal

基　　金：国家自然科学基金(81130029,81000604;81370036,81071199);首都卫生发展科研专项基金(2009-1004);协和青年基金;中央高校基本科研业务费专项基金(3332013105);阜外科研新星基金(2012-FWXX01)

摘　　要：目的：探讨延迟增强磁共振显像（DE—MRI）对冠心病心功能不全患者行冠状动脉旁路移植术（CABG）后心功能改善的预测价值。方法：2009-11至2011-11，35例合并心功能小全的陈旧性心肌梗死患者在CABG术前行DE—MRI检查，CABG术后6个月再次行DE—MRI检查评价心功能改善情况，同时行电子计算机X射线断层血管造影检查以了解桥血管通畅情况，结果：最终纳入31例患者进行分析（4例患者因桥血管闭塞而排除）。整体心功能改善的患者共22例．木改善的患者9例。单因素分析显示：受累节段、存活心肌节段、搬痕心肌竹段以及延迟增强（DE）评分是影响患者心功能改善的危险因素。而多因素Logistic回归分析则湿示瘢痕心肌节段数是预测患者心功能改善的唯一独市影响因素（比值比=6．097，95％可信区间：1．066～34．866，P=0．042）。受试者工作特征曲线显示瘢痕心肌节段≤4可很好地预测患者心功能改善，敏感性和特异性分别为95．5％和88．9％。结论：基于DE—MRI检查的瘢痕心肌节段数能够预测冠心病心功能不全患者行CABG术后的心功能改善，有待于进一步大样本研究。Objective： To evaluate the predictive value of delayed-enhancement magnetic resonance imaging （DE-MRI） for measuring the improvement of cardiac function in patients with coronary artery disease （CAD） combining heart failure （HF） after coronary artery bypass grafting （CABG）. Methods： A total of 35 CAD patients combining HF were examined by DE-MRI before receiving CABG, and they were re-examined at 6 months after CABG by DE-MRI and computed tomography angiography （CTA） in our hospital from 2009-11 to 2011-11 to evaluate the improvement of cardiac function and the graft patency. Results： There were 31 patients enrolled for analysis, 4 excluded for graft failure. 22 patients had the global functional improvement and 9 remained the same. Univariate analyses demonstrated that spatial extent, the number of viable segments and scar segments, DE score were the independent risk factors affecting the improvement of cardiac Conclusion： The number of scar segments based on DE-MRI detection for predicting the improvement of cardiac function in CAD patients with HF after CABG needs further investigation in large group of patients.

关 键 词：心肌梗死 延迟增强磁共振显像 冠状动脉旁路移植术 

分 类 号：R541[医药卫生—心血管疾病]