心脏磁共振评估冠状动脉慢性完全闭塞性病变患者左心室心肌应变的临床价值  

Clinical value of left ventricular strain analysis by cardiovascular magnetic resonance in patients with coronary chronic total occlusion

作　　者：张丽君[1] 田晋帆 杨雪瑶 徐磊[1] 贺毅 宋现涛[2] Zhang Lijun;Tian Jinfan;Yang Xueyao;Xu Lei;He Yi;Song Xiantao(Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,100029 [2]首都医科大学附属北京安贞医院心内科,100029 [3]首都医科大学附属北京友谊医院医学影像科,100050

出　　处：《中华心血管病杂志》2021年第6期601-609,共9页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81671650,81971569);首都卫生发展专项(2018-2-2063);2018年“北京市优秀人才骨干”(2018000021469G241)。

摘　　要：目的探讨应用心脏磁共振(CMR)组织追踪技术定量评估冠状动脉慢性完全闭塞性病变(CTO)患者左心室心肌应变的临床应用价值。方法该研究为回顾性、观察性研究。入选2014年11月至2019年1月在北京安贞医院行CMR检查的单支CTO患者作为病例组(即CTO组),另选取同期经超声心动图、心电图和临床病史等排除的无心血管疾病且CMR无异常表现的人群作为健康对照组(即对照组)。通过电子病历系统提取入选者的年龄、性别、出院诊断等一般临床资料及超声心动图、心电图检查结果。采用组织追踪技术测量左心室心肌应变参数,包括整体径向应变峰值(GPRS)、周向应变峰值(GPCS)和纵向应变峰值(GPLS),并分析CTO靶血管区心肌应变情况。采用灰度阈值5个标准差法测量心肌梗死面积,然后分别根据心肌梗死面积和左心室射血分数(LVEF)将CTO组患者进一步分为心肌梗死面积>10%组和≤10%组,以及LVEF≥50%组和<50%组。比较CTO组及其各亚组与对照组相关参数的差异。结果CTO组入选患者52例,男性34例,年龄(54.1±11.7)岁,体重指数(26.2±2.5)kg/m2,对照组入选30人,男性14人,年龄(51.6±12.3)岁,体重指数(25.6±3.3)kg/m2,两组间年龄、性别及体重指数差异均无统计学意义(P均>0.05)。与对照组比较,CTO组患者LVEF、GPRS、GPCS、GPLS均较低(P<0.05),而左心室容积(LVEDV)差异无统计学意义(P=0.32)。CTO组患者中心肌梗死面积>10%组26例、≤10%组26例。与对照组比较,心肌梗死面积≤10%组的CTO患者的LVEF和LVEDV差异均无统计学意义(P均>0.05),而GPRS、GPCS、GPLS均较低(P均<0.05)。与对照组比较,梗死面积>10%组的CTO患者的LVEDV差异无统计学意义(P>0.05),而LVEF、GPRS、GPCS和GPLS均较低(P均<0.05)。与梗死面积≤10%组比较,梗死面积>10%组的CTO患者的LVEF、LVEDV和GPLS差异均无统计学意义(P均>0.05),而GPRS、GPCS则较低(P均<0.05)。CTO组患者中LVEF≥50%组40例,LObjective To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion(CTO)by cardiac magnetic resonance imaging(CMR)-feature tracking(CMR-FT)technique.Methods In this retrospective and observation study,patients with single CTO,who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019,were selected as case group(CTO group),and those without cardiovascular diseases defined by echocardiography,electrocardiogram(ECG)and clinical history and with normal CMR results were selected as healthy control group(control group).General clinical data including age,gender,discharge diagnosis,and the examination results of echocardiography and ECG were obtained from the electronic medical record system.Two-dimensional CMR-FT was applied to measure left ventricle(LV)global peak radial,circumferential,and longitudinal strains(GPRS,GPCS and GPLS,respectively),and the regional myocardial strain in the target vessel area of CTO was analyzed.Grayscale thresholds of 5 standard deviations(SDs)were used to quantify late gadolinium enhancement(LGE).Patients with CTOs were divided into infract size>10%group and infarct size≤10%group,and left ventricular ejection fraction(LVEF)≥50%group and LVEF<50%group,respectively.The differences between various groups were compared.Results There were 52 patients in CTO group(34 males,age(54.1±11.7)years,body mass index(BMI)(26.2±2.5)kg/m2)and 30 patients in control group(14 males,age(51.6±12.3)years,BMI(25.6±3.3)kg/m2).There was no significant difference in age,gender,and BMI between the two groups(all P>0.05).LVEF,GPRS,GPCS and GPLS were significantly lower in CTO group than in control group(all P<0.05),left ventricular volume(LVEDV)was similar between the two groups(P>0.05).Among the patients with CTO,there were 26 patients with infarct size>10%and 26 patients with infarct size≤10%.GPRS,GPCS and GPLS were significantly lower(all P<0.05),while LVEF and LVEDV were similar in CTO patient

关 键 词：冠状动脉疾病 磁共振成像 心肌应变 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.3[医药卫生—诊断学]