心肌梗死患者基于CMR-FT评价的机械离散与QTc间期的相关性研究  

Correlation Between Mechanical Dispersion Based on CMR-FT Evaluation and QTc Interval in Myocardial Infarction

作　　者：张莉[1] 赵晓莹 张晚秋 杨砾寒 赵新湘[1] ZHANG Li;ZHAO Xiaoying;ZHANG Wanqiu(Department of Radiology,Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650101,P.R.China)

机构地区：[1]昆明医科大学第二附属医院放射科,650101

出　　处：《临床放射学杂志》2024年第7期1101-1106,共6页Journal of Clinical Radiology

基　　金：云南省科技厅昆医联合专项重点项目(编号:202201AY070001-097);云南省“心脑同治”临床医学类关键新技术研发项目(编号:202203AC100007);国家自然科学基金项目(编号:82160332);云南省多中心缺血性心肌病CMR评价与风险分层项目(编号:YXJL-2022-0665-0214);云南省赵世华专家工作站(编号:470202305AF150033);昆明医科大学研究生教育创新基金资助项目(编号:2023S305)。

摘　　要：目的探索心肌梗死(MI)患者基于心脏磁共振组织特征追踪技术(CMR-FT)评价的左室机械离散(LVMD)与心电参数QTc间期(校正QT间期)的相关性。方法纳入经临床及CMR确诊的MI患者,根据随访结果分为心血管主要不良事件(MACE)组和无MACE组。左室功能参数包括:左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、应变参数衍生参数LVMD;心电图参数QTc间期,CMR和心电图采集时间为同一周内。采用独立样本t检验、Mann-Whitney U秩和检验及χ^(2)检验比较两组患者的基线资料、左室功能和应变参数,运用Spearman相关性分析LVMD与QTc间期、长QTc间期(QTc间期>440 ms)和正常QTc间期的相关性,再进一步分析MI后MACE组和无MACE组患者LVMD与QTc间期的相关性。结果最终纳入169例MI患者,中位随访时间为25个月,MACE组56例,无MACE组113例。两组患者的年龄、LVEF、QTc间期、LVMD差异具有统计学意义(均P<0.05)。Spearman相关性分析显示,LVMD与QTc间期(r_(s)=0.590,P<0.001)、长QTc间期(QTc间期>440 ms)(r_(s)=0.542,P<0.001)及正常QTc间期(320≤QTc间期≤440 ms)(r_(s)=0.249,P=0.033)均具有正相关。MACE组患者LVMD与QTc间期的相关性(r_(s)=0.544,P<0.001)高于无MACE组(r_(s)=0.358,P=0.001)。结论在MI患者中,CMR评价的LVMD与心电参数QTc间期和长QTc间期呈正相关,这种相关性在长QTc间期和MACE组的MI患者中更为明显,这提示LVMD随着QTc间期的延长而增加;MACE的发生风险可能与LVMD的增加和QTc间期的延长有关,这有助于对MI患者MACE风险分层更深入的认知。Objective To explore the correlation between left ventricular mechanical dispersion(LVMD)and QTc(corrected QT interval)of ECG parameters in patients with myocardial infarction(MI)based on cardiac magnetic resonance tissue feature tracking(CMR-FT).Methods According to the followed-up,MI diagnosed by clinical and CMR were enrolled and divided into two groups according to the presence or absence of MACEs during follow-up.Left ventricular functional parameters,including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and LVMD derived from strain parameter were obtained by software CVI 42.QTc interval obtained by ECG,these parameters were acquired within the same week.Independent samples t-test,Mann-Whitney U test,and χ^(2) test were used to compare the baseline data,left ventricular function,and strain parameters between the two groups.Spearman correlation analysis was applied to analyze the correlation between LVMD and QTc interval,long QTc interval(QTc interval>440 ms),and regular QTc interval,and further explored the correlation between LVMD and QTc interval in the MACE group and without MACE group in MI patients.Results A total of 169 patients with MI were included,with a median follow-up of 25 months,56 in the MACE group and 113 in the without MACE group.Significant differences were observed in age,LVEF,QTc interval,and LVMD between the two groups(all P<0.05).Spearman correlation analysis showed that LVMD was positively associated with QTc interval(r_(s)=0.590,P<0.001),long QTc interval(r_(s)=0.542,P<0.001),and regular QTc interval(r_(s)=0.249,P=0.033).The correlation between LVMD and QTc interval was higher in patients in the MACE group(r_(s)=0.544,P<0.001)than in the without MACE group(r_(s)=0.358,P=0.001).Conclusion LVMD evaluated by CMR was positively correlated with the electrocardiographic parameters QTc interval and long QTc interval.The correlation between LVMD and QTc interval was more significant in MI patients with long

关 键 词：心肌梗死 心肌机械离散 QTC间期 心血管主要不良事件 心脏磁共振组织特征追踪成像技术 

分 类 号：R542.22[医药卫生—心血管疾病]