Cardiac magnetic resonance imaging can evaluate early cardiac function in patients with acute myocardial infarction
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摘要:
目的 探讨心脏磁共振对急性心肌梗死患者早期心功能状态评估价值。 方法 选择2022年6月~2022年12月在我科住院并确诊的急性ST段抬高型心肌梗死患者24例，男性22例，女性2例，年龄55.3±11.3岁。所有患者均在入院后行冠状动脉介入手术，并在术后5~7 d行心脏磁共振检查。应用电影成像技术分析心功能状态、是否存在反向运动和室壁瘤；组织追踪技术分析心肌各节段的应变能力；延迟强化技术分析心肌梗死部位、梗死面积大小和是否存在微循环障碍。结果梗死节段心肌应变分析显示：24例患者中，21例患者径向应变下降，18例患者周向应变下降，21例患者纵向应变下降，16例患者三向应变均下降；整体心肌应变分析显示：15例患者径向应变下降，10例患者周向应变下降，20例患者纵向应变下降，9例患者三向应变均下降；梗死节段心肌平均径向应变和周向应变低于整体心肌平均径向应变和周向应变（P < 0.05），梗死节段与整体心肌纵向应变的差异无统计学意义（P > 0.05）。13例患者出现心肌反向运动；左室射血分数（LVEF）下降者10例；LVEF未下降的14例中，心肌反向运动6例，梗死节段三向心肌应变下降6例，梗死区内微循环障碍7例，NT-proBNP水平升高7例。出现反向运动组患者LVEF、梗死节段心肌和整体心肌平均周向应变、纵向应变均小于未出现反向运动组患者（P < 0.05）。相关性分析显示：LVEF与心肌整体应变、梗死节段应变和左房射血分数呈正相关关系，与心肌梗死面积、左室收缩末期容积/体表面积比值、NT-proBNP水平和Genisini评分呈负相关关系（P < 0.05）。二元Logistic回归显示，梗死节段纵向应变的降低可以独立预测患者是否出现心肌反向运动。 结论 心脏磁共振技术可以多角度评价心功能状态，对急性心肌梗死患者术后早期心功能评估、治疗和干预，改善患者的预后提供参考依据。 Abstract:Objective To explore the value of cardiac magnetic resonance imaging in evaluating early cardiac function in patients with acute myocardial infarction. Methods The study included 24 patients with acute ST-segment elevation myocardial infarction who were admitted to our department from June 2022 to December 2022, including 22 male patients and 2 female patients, with the age at 55.3±11.3 years old. All patients underwent coronary intervention followed by cardiac magnetic resonance imaging 5-7 d after the operation. Motion picture imaging was used to analyze cardiac function status, presence or absence of reverse motion and ventricular aneurysm. The strain capacity of each myocardium segment was analyzed by tissue tracking technique. The location, size and microcirculation disturbance of myocardial infarction were analyzed by delayed enhancement technique. Results Myocardial strain analysis revealed that 21 patients were found to have decreased radial strain and longitudinal strain among the 24 patients, 18 had decreased circumferential strain, and 16 showed a reduction in the three-dimensional myocardial strain. According to the overall analysis of the myocardial strain revealed that 15 patients revealed decreased radial strain, 10 had decreased circumferential strain, 20 had decreased longitudinal strain, and 9 showed a reduction in three-dimensional myocardial strain. The mean radial strain and circumferential strain of the MI segment were significantly lower than that of the average radial strain and circumferential strain of the entire myocardium (P < 0.05), but no statistically significant difference was observed in the longitudinal strain (P > 0.05). Moreover, 13 patients were observed to have myocardial reverse movement. There were 10 and 14 patients with and without decreased left ventricular ejection fraction, respectively, among which 6 had myocardial reverse movement, 6 showed a decrease in three-dimensional myocardial strain in the infarcted segment, 7 presented microcirculatory disturbance within the infarct zone, and 7 had increased level of NT-proBNP. The mean circumferential and longitudinal strains of left ventricular ejection fraction, infarct segment myocardium and global myocardium in patients with reverse motion were all smaller than those without reverse motion (P < 0.05). Correlation analysis indicated that left ventricular ejection fraction was positively correlated with the overall myocardial strain, myocardial strain in the infarcted segment and left atrial emptying fraction. It was negatively correlated with infarct size, left ventricular end-systolic volume/body surface area ratio, NT-proBNP level and Gensini score (P < 0.05). The binary Logistic regression analysis showed that the reduction in the longitudinal strain in the infarcted segments could independently predict whether patients possessed myocardial reverse movement. Conclusion Cardiac magnetic resonance imaging provides a comprehensive evaluation of the cardiac function status, which will be a reference for patients with acute myocardial infarction, offering valuable insights into the improvement of early post-operative cardiac function assessment, treatment, intervention and prognosis. -
图 1 前壁心肌梗伴微循环障碍2例
Figure 1. Anterior myocardial infarction with microcirculation disturbance in 2 cases.
图 2 下壁心肌梗死伴微循环障碍2例
Figure 2. Inferior myocardial infarction with microcirculation disturbance in 2 cases.
图 3 前壁心肌梗死伴反向运动电影序列图像
Figure 3. Anterior myocardial infarction with reverse motion in film sequence images.
图 4 前壁心肌梗死心肌应变下降
Figure 4. Anterior myocardial infarction myocardial strain decreased.
图 5 下壁心肌梗死心肌应变下降
Figure 5. Inferior myocardial infarction myocardial strain decreased.
图 6 前壁心肌梗死应变下降伴反向运动
Figure 6. Anterior myocardial infarction decreased myocardial strain with reverse movement.
图 7 下壁心肌梗死应变下降伴反向运动
Figure 7. Inferior myocardial infarction decreased myocardial strain with reverse movement.
表 1 心肌应变分析
Table 1. Myocardial strain analysis(%, Mean±SD)
Myocardial strain Myocardial strain in infarct segment Global myocardial strain P Radial strain 7.74±8.95 28.06±10.42 0.001 Circumferential strain -12.18±-4.12 -15.69±-3.81 0.004 Longitudinal strain -10.92±-3.99 -11.96±-4.30 0.392 
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表 2 反向运动分析
Table 2. Reverse motion analysis (Mean±SD)
Index Reverse motion group Non-reverse motion group P Age（year) 56.2±10.6 54.2±12.5 0.673 LVEF(%) 43.77±15.51 55.27±10.06 0.041 LGE(%) 22.90±12.05 16.72±10.92 0.202 LVEDV/BSA 72.19±12.05 73.31±19.45 0.887 LVESV/BSA 42.03±19.56 32.88±14.40 0.201 RS(%) 14.52±7.86 21.54±9.00 0.057 CS(%) 10.55±4.09 14.10±3.40 0.030 LS(%) 9.13±3.14 13.03±3.97 0.016 TRS(%) 26.37±10.83 30.05±10.05 0.397 TCS(%) 14.23±3.98 17.43±2.90 0.033 TLS(%) 10.25±3.85 13.97±4.07 0.033 LAEF(%) 53.54±13.44 59.27±12.53 0.292 LAEF: Left atrial ejection fraction: LVEF: Left ventricular ejection fraction; LGE: Late gadolinium enhancement; LVEDV/BSA: Left ventricular end-diastolic volume/body surface area; LVESV/BSA: Left ventricular end-systolic volume/body surface area; RS: Radial strain; CS: Circumferential strain; LS: Longitudinal strain; TRS: Total radial strain; TCS: Total circumferential strain; TLS: Total longitudinal strain.
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表 3 LVEF相关性分析
Table 3. LVEF correlation analysis
Index R P Age -0.237 0.264 LGE(%) -0.620 0.001 LVEDV/BSA -0.402 0.051 LVESV/BSA -0.836 < 0.001 RS(%) 0.674 < 0.001 CS(%) 0.722 < 0.001 LS(%) 0.785 < 0.001 TRS(%) 0.748 < 0.001 TCS(%) 0.900 < 0.001 TLS(%) 0.736 < 0.001 LAEF(%) 0.754 < 0.001 NT-proBNP -0.702 < 0.001 Gensini -0.429 0.036
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