心肌梗死致心肌瘢痕患者与二尖瓣关闭不全程度的关系  

The relationship between myocardial scar caused by myocardial infarction and degree of mitral regurgitation

作　　者：朱恩军[1] 李进华[1] 刘岳[1] 任长伟[1] 戴江[1] 刘克敏 王生伟 来永强[1] ZHU Enjun;LI Jinhua;LIU Yue;REN Changwei;DAI Jiang;LIU Kemin;WANG Shengwei;LAI Yongqiang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2020年第2期160-163,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:缺血性二尖瓣关闭不全是由缺血性心肌病引起的左心室重构,瓣叶牵拉所导致。本研究通过心脏核磁延迟强化成像分析左心室心肌瘢痕对冠心病患者发生中重度缺血性二尖瓣关闭不全的预测作用。方法:本研究回顾性分析2015年1月1至2018年12月31日,在北京安贞医院就诊的冠心病患者,共有111例患者符合入排标准入选本研究。应用心脏核磁延迟强化成像定量技术,计算左心室心肌瘢痕总量,乳头肌瘢痕及左心室前壁、间隔壁、下壁、侧壁瘢痕量。应用Logistic回归分析探索与冠心病患者发生中重度缺血性二尖瓣关闭不全相关的左心室心肌瘢痕情况。结果:多因素Logistic回归结果分析提示:左心室心肌瘢痕总量(RR=1.02,95%CI:1.002~1.03,P<0.05)及乳头肌瘢痕(RR=3.45,95%CI:1.03~11.58,P<0.05)与冠心病患者发生中重度缺血性二尖瓣关闭不全相关,而左心室各壁瘢痕量与冠心病发生中重度缺血性二尖瓣关闭不全无相关性。结论:左心室心肌瘢痕总量及乳头肌瘢痕是冠心病患者发生中重度缺血性二尖瓣关闭不全的危险因素。Objective:Ischemic mitral regurgitation(IMR)occurs frequently after myocardial infarction(MI)due to left ventricular(LV)global or regional remodeling.This study aimed to determine whether myocardial scar in left ventricle was associated with the incidence of moderate-severe IMR in patients with coronary heart disease.Methods:A total of 111 patients with coronary heart disease who were examined with Cardiac magnetic resonance(CMR)in our hospital from January 2015 to December 2018 were included in this study.All patients were examined with CMR for the myocardial scar quantification using the late gadolinium enhancement(LGE)technique.The scar quantification of 16 segments in left ventricle were calculated to obtain the quantified scar result of total left ventricle and 5 different positions in left ventricle as anterior wall,lateral wall,partition,inferoposterior wall and papillary muscles.Logistic multivariate analysis was conducted to explore the relationship between the myocardial scar and the incidence of moderate-severe IMR in patients with coronary heart disease.Result:Total left ventricle scar(RR=1.02,95%CI:1.002-1.03,P<0.05)and papillary muscles scar(RR=3.45,95%CI:1.03-11.58,P<0.05)were associated with the incidence of moderate-severe IMR in patients with coronary heart disease.Conclusions:Total left ventricle scar and papillary muscles scar were the independent risk factors influencing the incidence of moderate-severe IMR in patients with coronary heart disease.

关 键 词：缺血性二尖瓣关闭不全 心肌瘢痕 危险因素 

分 类 号：R54[医药卫生—心血管疾病]