新型冠状病毒感染相关心肌炎的心脏磁共振特征  

Cardiac Magnetic Resonance Imaging Characteristics of Patients with COVID-19 Associated Myocarditis

作　　者：王艺宁 周笛 徐晶 杨文静 蒋梦迪 朱乐怡 张华莹 赵世华[1] 陆敏杰[1] WANG Yining;ZHOU Di;XU Jing(Department of Magnetic Resonance Imaging,Peking Union Medical College&Chinese Academy of Medical Sciences,Fuwai Hospital,National Center for Cardiovascular Diseases,Beijing 100037,P.R.China)

机构地区：[1]国家心血管病中心,北京协和医学院,中国医学科学院阜外医院磁共振影像科,北京100037

出　　处：《临床放射学杂志》2025年第4期631-637,共7页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:82471973);北京市自然科学基金项目(编号:7242110);高水平医院临床研究青年重点项目(编号:2022 GSP QZ 5);北京协和医学院2023年度本科教育教学改革项目(编号:2023zlgl026)。

摘　　要：目的探讨新型冠状病毒感染(COVID-19)相关心肌炎的心脏磁共振(CMR)特征及预后价值。方法回顾性纳入经CMR诊断急性心肌炎且经鼻咽拭子或特异性抗体确诊COVID-19的患者42例,对照组为性别、年龄匹配的急性心肌炎患者45例。通过黑血序列、电影序列、T_(2)W-STIR序列、钆对比剂延迟强化序列以及T_(1)和T_(2)mapping序列评估两组患者的CMR特征,并比较两组患者的短期预后。结果与对照组相比,COVID-19相关心肌炎患者的超敏肌钙蛋白I(P=0.040)及N端脑钠肽前体(P=0.026)水平略低,大多数患者为纽约心脏病学会心功能Ⅰ~Ⅱ级[78.6%(33/42)vs.57.8%(26/45),P=0.038]。COVID-19相关心肌炎患者具有更高的左心室射血分数[(59.3±9.8)%vs.(48.0±15.8)%,P<0.001]与更低的左心室收缩末期容积指数[(32.2±12.4)ml/m^(2)vs.(45.6±29.7)ml/m^(2),P=0.009]。此组患者更少出现钆延迟强化[50.0%(21/42)vs.80.0%(36/45),P=0.015]与室壁运动异常[21.4%(9/42)vs.53.3%(24/45),P=0.002];同时,延迟强化范围[1.4(0.0,4.7)%vs.7.5(2.4,19.5)%,P=0.001]、Native T_(1)值[(1318±83)ms vs.(1382±139)ms,P=0.014]、细胞外容积[(32.8±5.4)%vs.(35.9±7.6)%,P=0.009]和T_(2)值[(49.9±7.1)ms vs.(56.2±10.6)ms,P=0.009]更低。随访时间为347(218,421)天,非COVID-19相关心肌炎组患者中出现5次主要不良心血管事件,包括3次心源性死亡,1次心脏移植和1次因心力衰竭入院,而COVID-19相关心肌炎组中仅出现2次心源性死亡。结论COVID-19相关心肌炎患者心肌损伤较非COVID-19相关心肌炎轻,但仍存在发生心血管不良事件的可能性,CMR对于患者的临床诊疗与预后有较高价值。Objective To investigate the cardiac magnetic resonance characteristics and short-term prognosis of coronavirus disease 2019(COVID-19)-associated myocarditis.Methods Forty-two patients with acute myocarditis diagnosed by cardiac magnetic resonance and COVID-19 infection confirmed by nucleic acid testing or specific serological antibodies against SARS-CoV-2 were retrospectively enrolled,and the control group consisted of 45 gender-and age-matched patients with acute myocarditis.The CMR sequences included cine-SSFP,T_(2)STIR,late gadolinium enhancement,T_(1)and T_(2)mapping.Results Patients with COVID-19-associated myocarditis had lower levels of hs-troponin I and N-terminal pro atrial natriuretic peptide compared to controls,and the majority of patients were in New York Heart Association functional classⅠorⅡ.Patients with COVID-19 associated myocarditis had a higher left ventricular ejection fraction[(59.3±9.8)%vs(48.0±15.8)%,P<0.001]with a lower left ventricular end-systolic volume index(P=0.009).Patients in this group were less likely to have delayed gadolinium enhancement(P=0.015)and ventricular wall motion abnormalities(P=0.002).Native T_(1)values[(1318±83)ms vs.(1382±139)ms,P=0.014],extracellular volume[(32.8±5.4)%vs.(35.9±7.6)%,P=0.009]and T_(2)values[(49.9±7.1)ms vs.(56.2±10.6)ms,P=0.009]were lower in this group.Over a mean follow-up of 347(218,421)days,there were five major adverse cardiovascular events(three cardiac deaths,one heart transplantation and one heart failure readmission)in the non-COVID-19 associated myocarditis group.Only two cardiac deaths occurred in the COVID-19 associated myocarditis group.Conclusion Patients with COVID-19 associated myocarditis has less severe myocardial damage,and cardiac magnetic resonance imaging is of great value in the clinical diagnosis and prognosis of these patients.

关 键 词：磁共振成像 心肌炎 新型冠状病毒感染 

分 类 号：R54[医药卫生—心血管疾病]