急性ST段无偏移型心肌梗死患者的心脏核磁共振特征分析  

Analysis of cardiac magnetic resonance features in patients with acute ST-segment unoffset myocardial infarction

作　　者：张路遥 董淑娟 李静超 陈文剑 李晓栋[2] 楚英杰 ZHANG Lu-yao;DONG Shu-juan;LI Jing-chao;CHEN Wen-jian;LI Xiao-dong;CHU Ying-jie(Department of Cardiology,Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Radiology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院,河南省人民医院心内科,郑州450003 [2]河南省人民医院放射科,郑州450003

出　　处：《医药论坛杂志》2022年第15期1-6,共6页Journal of Medical Forum

基　　金：河南省重点科技攻关计划(122102310068)。

摘　　要：目的通过与急性ST段压低型心肌梗死(ST segment depression myocardial infarction,STDMI)的对比,分析急性ST段无偏移型心肌梗死(ST segment unoffset myocardial infarction,STUMI)患者的心脏核磁共振(cardiac magnetic resonance,CMR)特征。方法连续纳入2020年5月至2021年12月就诊于河南省人民医院,诊断为非ST段抬高型心肌梗死(non-ST elevated myocardial infarction,NSTEMI),且于发病24 h内行急诊介入治疗,收集患者的心电图、冠脉造影及CMR等检查结果,分析两组患者CMR特征的差异。结果STUMI组患者透壁性心肌梗死的发生率显著高于STDMI组(P=0.020)。相比于STDMI患者,STUMI患者梗死面积(P=0.009)、相对危险心肌(P=0.021)、梗死透壁程度(P=0.009)更高;而STUMI组患者的左室射血分数(P=0.012)低于STDMI组。对所有NSTEMI患者发生透壁性心肌梗死进行单因素和多因素logistic回归分析,结果显示:缺血时间延长(P=0.001)和缺乏良好的侧支循环(P=0.014)、IRA完全闭塞(P=0.001)是发生透壁性心肌梗死的独立危险因素。结论STUMI作为一种特殊类型的NSTEMI,CMR多表现为透壁性心肌梗死,梗死面积和相对危险心肌较STDMI更大,而左室射血分数较小。缺血时间、无侧支循环形成和术前TIMI血流0~1级是NSTEMI患者发生透壁性心肌梗死的独立预测因素。Objective To analyze the cardiac magnetic resonance(CMR)characteristics in patients with acute ST seg⁃ment unoffset myocardial infarction(STUMI)by comparing with acute ST segment depression myocardial infarction(STDMI)patients.Methods The patients who were admitted to Henan Provincial People’s Hospital from May 2020 to December 2021 and were diagnosed with Non-ST Elevated Myocardial Infarction(NSTEMI)were included.All pa⁃tients received Coronary angiography and CMR,and the differences in CMR characteristics were analyzed between the two groups.Results The incidence of transmural myocardial infarction in the STUMI group was significantly higher than that in the STDMI group(P=0.020).Compared with STDMI patients,STUMI patients had larger infarct size(P=0.009),more relative myocardial risk(P=0.021)and higher infarct transmural degree(P=0.009);While STUMI group patients had lower left ventricular ejection fraction(P=0.012)than the STDMI group.Univariate and multivari⁃ate logistic regression analysis of transmural myocardial infarction in all NSTEMI patients showed:prolonged ischemia time(P=0.001)and lack of collaterals(P=0.014),IRA complete occlusion(P=0.001)were independent risk fac⁃tors for transmural myocardial infarction.Conclusion As a type of NSTEMI,STUMI patients have more incidence of transmural myocardial infarction shown in the CMR.The infarct size and relative risk of myocardial infarction in STUMI patients are larger than those in STDMI patients,while the left ventricular ejection fraction is smaller.Ischemia time,no collateral circulation and preoperative TIMI blood flow 0-1 are independent predictors of transmural myocardial infarction in NSTEMI patients.

关 键 词：ST段无偏移型心肌梗死 ST段压低型心肌梗死 心脏核磁共振 透壁性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]