心脏磁共振Native T1在Takotsubo综合征和左前降支梗阻型急性心肌梗死中的鉴别诊断价值  

The value of Native T1 in the differential diagnosis of Takotsubo syndrome and acute myocardial infarction caused by left anterior descending coronary artery obstruction

作　　者：苏燕萍 卢陈英[1] 吕玲春[2] 郑沈菲 王君禾 陈敏江[3] 纪建松[1,3] SU Yanping;LU Chenying;LYU Lingchun;ZHENG Shenfei;WANG Junhe;CHEN Minjiang;JI Jiansong(Department of Radiology,Lishui Central Hospital,Lishui 323000,China;Department of Cadiology,Lishui Central Hospital,Lishui 323000,China;Key Laboratory of Imaging Diagnosis and Minimally Invasive Research,Lishui Central Hospital,Lishui 323000,China;The First School of Medicine,School of Information and Engineering,Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]丽水市中心医院放射科,浙江丽水323000 [2]丽水市中心医院心内科,浙江丽水323000 [3]丽水市中心医院浙江省影像诊断与介入微创研究重点实验室,浙江丽水323000 [4]温州医科大学第一临床医学院(信息与工程学院),浙江温州325035

出　　处：《温州医科大学学报》2022年第9期697-704,共8页Journal of Wenzhou Medical University

基　　金：浙江省医药卫生科技计划面上项目(2020KY377,2021KY417)。

摘　　要：目的:探讨心脏磁共振(CMR)初始T1值(Native T1)在Takotsubo综合征(TTS)和左前降支梗阻型急性心肌梗死(AMI-LAD)中的鉴别诊断价值。方法:选取2018年1月至2022年2月就诊于丽水市中心医院的TTS患者13例,AMI-LAD患者26例,均行CMR检查,包括Cine、T2-STIR、T1-mapping、T2-mapping及钆对比剂延迟增强(LGE)序列。比较2组患者的一般资料和实验室检查结果,包括肌钙蛋白I(CTNI)、肌红蛋白(MYO)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、B型脑利钠肽(BNP),左室心功能参数包括射血分数(EF)、舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、心率(HR)、心输出量(CO)、心脏指数(CI),左室心肌应变参数包括全局径向应变(GSR)、全局环向应变(GSC)、全局纵向应变(GSL)及Native T1、细胞外容积(ECV)、初始T2值(Native T2)的组间差异。采用单因素和多因素Logistic回归分析筛选独立危险因素并进行建模分析。结果:TTS组女性患者为11例(84.2%),AMI-LAD组女性患者为11例(42.3%),TTS较AMI-LAD女性患者比例更高(P=0.012),且其BMI值较AMI-LAD组低(P=0.043)。相比于AMI-LAD,TTS组CTNI、CKMB水平明显降低,BNP、CRP、CK、LDH水平则明显升高(P<0.05),左心室及水肿节段平均Native T1、Native T2值较高,而ECV值较低(P<0.05)。多因素Logistic回归分析显示BNP(OR=1.001,95%CI=1.000~1.003,P=0.040)及Native T1(OR=1.021,95%CI=1.002~1.040,P=0.030)是TTS鉴别AMI的独立危险因素。ROC曲线分析结果显示BNP、Native T1、联合模型的AUC分别为0.852(95%CI=0.702~0.945)、0.911(95%CI=0.776~0.978)、0.920(95%CI=0.787~0.983),灵敏度分别为84.62%、84.62%、84.62%,特异度分别为76.92%、84.62%、96.15%。结论:Native T1在TTS和AMI-LAD的鉴别诊断中具有重要价值,联合BNP可提高鉴别诊断效能。Objective: To investigate the differential diagnostic value of cardiac magnetic resonance(CMR)Native T1 in Takotsubo syndrome(TTS) and acute myocardial infarction with left anterior descending coronary artery obstruction(AMI-LAD). Methods: 13 patients with TTS and 26 patients with AMI-LAD in Lishui Central Hospital from January 2018 to February 2022 were collected, who underwent 3.0 T CMR including Cine, T2STIR, T1 mapping, T2 mapping and late gadolinium enhancement(LGE) sequences. General data and serum biomarkers like CTNI, MYO, CK, CKMB, ALT, AST, CRP, LDH, BNP, and left ventricle function parameters like EF, EDV, ESV, SV, HR, CO, CI, and myocardial strains like GSR, GSC, GSL, and Native T1,ECV, and Native T2 of the two groups were compared. Univariate and multivariate Logistic regression analysis were used to screen independent risk factors and conduct modeling analysis. Results: TTS tends to occur in women, and tends to have lower BMI, CTNI, CKMB, but higher BNP, CRP, CK, and LDH. The left ventricle and edema segments in TTS have higher Native T1, T2, and lower ECV compared to AMI-LAD(P<0.05).Multivariate Logistic regression analysis suggested that BNP(OR=1.001, 95%CI=1.000-1.003, P=0.040) and Native T1(OR=1.021, 95%CI=1.002-1.040, P=0.030) were the independent risk factors for TTS differentiating from AMI. BNP, T1native. ROC curve analysis showed combined models had AUCs of 0.852(95%CI=0.702-0.945), 0.911(95%CI=0.776-0.978), and 0.920(95%CI=0.787-0.983), respectively. They had a sensitivity of 84.62%, 84.62%, and 84.62%, and a specificity of 76.92%, 84.62%, and 96.15%, respectively. Conclusion:Native T1 is of important value in the differential diagnosis of TTS and AMI-LAD, and when combined with BNP, it can improve the diagnostic efficiency.

关 键 词：NativeT1 Takotsubo综合征 急性心肌梗死 心脏磁共振 

分 类 号：R816.2[医药卫生—放射医学]