磁共振成像特征追踪技术测定左心室应变与急性心肌梗死透壁程度关系  

Correlating transmural extent of acute myocardial infarction to left ventricular stain by mrifeature tracking

作　　者：李俊超[1] 李梦露[2] 王晶[1] 周肖[1] 程流泉[2] 董蔚[1] 陈韵岱[1] 

机构地区：[1]解放军总医院心内科,北京100853 [2]解放军总医院放射科,北京100853

出　　处：《中国介入心脏病学杂志》2017年第12期664-670,共7页Chinese Journal of Interventional Cardiology

基　　金：临床特色优势技术项目(2015FC-TSYS-2004);"十二五"国家科技支撑计划课题(2011BAI11B10)

摘　　要：目的应用基于心脏磁共振成像(MRI)电影序列的特征追踪技术分析急性心肌梗死患者左心室心肌应变,探索其与急性心肌梗死透壁程度的关系,及急诊经皮冠状动脉介入治疗(PCI)术后心肌应变演变规律。方法入组74例急性ST段抬高型心肌梗死(STEMI)患者,均于急性心肌梗死12 h内接受急诊PCI,术后2~5 d,行心电门控稳态自由进动序列扫描采集电影序列图像,同时行钆对比剂延迟强化,得到短轴强化序列图像。其中20例3~5月后复查MRI。应用Tom Tec 2D CPA软件分析电影序列,得到局部心肌应变指标,(包括各节段内膜圆周、径向、纵向应变峰值),和整体心肌应变指标(包括整体圆周、径向、纵向应变值),应用Segment分析软件计算延迟强化序列各个节段心肌梗死透壁程度。结果本研究74例STEMI患者,梗死面积为(11.81±7.28)%。分析得到537个无梗死节段,425个非透壁梗死节段,182个透壁梗死节段。圆周应变峰值基底段无梗死节段(–23.90±10.92)%、非透壁梗死节段(–18.94±10.51)%、透壁梗死节段(–14.24±9.05)%,两两比较发现,无梗死节段指标(取绝对值)显著高于非透壁梗死节段(P=0.000),非透壁梗死节段指标显著高于透壁梗死节段(P=0.016)。圆周应变峰值中间段无梗死节段(–22.13±9.98)%、非透壁梗死节段(–17.47±8.72)%、透壁梗死节段(–12.71±8.92)%,两两比较发现,无梗死节段指标(取绝对值)显著高于非透壁梗死节段(P=0.000),非透壁梗死节段指标显著高于透壁梗死节段(P=0.000)。圆周应变峰值心尖段无梗死节段(–22.46±10.31)%、非透壁梗死节段(–19.51±12.49)%、透壁梗死节段(–13.81±11.13)%,两两比较发现,透壁梗死节段指标(取绝对值)显著低于无梗死节段(P=0.000)与非透壁梗死节段(P=0.001),但无梗死节段与非透壁梗死节段指标比较,差异无统计学意义。纵向应变峰值在基底段与中间段,无梗死节段、非透壁梗死节段�Objective The left ventricular myocardial strain of acute myocardial infarction on cardiac magnetic resonance cine imaging was measured by feature tracking technique. The relationship between left ventricular myocardial strain and the transmural extent of Myocardial Infarction was evaluated. Methods 74 patients with acute ST segment elevation myocardial infarction were included. All theses patients received primary PCI within 12 hours. After 2 to 5 days. ECG gated steady-state free precession sequences were collected. Gadolinium contrast enhanced imaging was performed on short axis. 20 patients repeated same scan after 3 to 5 months. Tom Tec 2 D CPA and Segment software were used to analyze the images. The peak values of the regional myocardial strain indexes. The transmural extent of myocardial infarction of segment in left ventricular was measured. Results There was no significant difference of longitudinal strain in noninfarction, non-transmural infarction and transmural infarction segments at the basal and middle segments. The circumferential strain peak and the radial strain peak of non-transmural infarction segments were lower than those of the non-infarction segments. The circumferential strain of transmural infarction segments were the lowest（basal level：–14.24%±9.05%,P〈0.05;middle level：–12.71%±8.92%, P〈0.05;apical level：–13.81%±11.13%,P〈0.05）. GLS was improved while LVDd was increased when compared the acute phase of myocardial infarction to that of 3-5 months after primary PCI. The circumferential strain and longitudinal strain of the nontransmural infarction segments was improved. The circumferential strain and radial strain of the transmural infarction segments 3-5 months later was improved as compared to the acute phase. Conclusions There was differences in myocardial strain in non-infarction, non-transmural infarction and transmural infarction segments from patients with acute ST segment elevation myocardial infarction who had accepted primary PCI. The circumferential strai

关 键 词：特征追踪技术 心脏磁共振成像 急性心肌梗死 心肌应变 

分 类 号：R542.22[医药卫生—心血管疾病]