冠心病延迟增强MRI与心脏事件相关性研究

Assessment of myocardial infarction with delayed-enhancement MRI in coronary artery disease： a correlative study with cardiac events

目的探讨延迟增强MRI（DE—MRI）检测心肌梗死积分与近期心脏事件的相关性。方法40例经完整资料确诊的冠心病患者行DE—MRI心肌梗死积分评价、超声心动图射血分数（EF）测量、每周硝酸甘油次数、每周心绞痛发作次数及最近1年心功能不全发作次数、6min步行距离评价及西雅图心绞痛健康状况（SAQ）评分。结果行Separman秩相关分析、完全随机设计多个样本比较及两两比较。结果DE—MRI心肌梗死积分[12分（四分位数间距：6．0～19．8分）]与6min步行距离（378．93±100．53）、SAQ（74．55±11．40）呈轻至中度负相关（r值分别为0．66、0．54，P〈0．05）；每周硝酸甘油次数[1次（四分位数间距：0～2．8次）]、每周心绞痛发作次数[3次（四分位数间距：1．0～6．5次）]及最近1年心功能不全发作次数[0次（四分位数间距：0～2次）]呈高度正相关（r值分别为0．87、0．85、0．89，P值均〈0．05），高于EF值[（49．2±13．72）％]与相应心脏事件的相关系数。结论DE—MRI检测的心肌梗死积分可用于近期心脏事件发生的预测，相对于传统的EF评价，其对于冠心病近期心脏事件发生的预测有更高的价值。

Objective To investigate the correlation between recent cardiac events and the score of myocardial infarction by delayed-enhancement MRI （DE-MRI）. Methods DE-MRI was performed in 40 subjects with coronary artery disease. The score of myocardial infarction by DE-MRI, the ejection fraction （EF） by echoeardiography, recent cardiac events （the number of weekly nitroglycerin, the number of weekly angina episodes and the onset number of heart failure in the last year） , 6-minute walking distance, as well as the Seattle angina questionnaire （SAQ） score were assessed. The Spearman correlation test and Kruskal-Wallis test, Mann-Whitney test were used for the statistics. Results There were negative correlation between the myocardial infarction score by DE-MRI （median 12, inter-quartile range： 6. 0±19. 8） and the 6-minute walking distance（378.93± 100. 53 ） , SAQ score （74. 55 ± 11.40 ） （ r was 0. 66 and 0. 54, P 〈 0. 05）. The myocardial infarction score by DE-MRI was strongly correlated with the number of weekly nitroglycerin （ median 1 ; inter-quartile range ： 0-2. 8 ）, the number of weekly angina episodes （ median 3, inter-quartile range： 1-6. 5 ） and the onset number of heart failure in the last year （median 0, inter-quartile range： 0-2） （r was 0. 87,0. 85 and 0. 89, P 〈0. 05） . EF [ （49.2 ± 13.72）% ] was negative correlation with the number of weekly nitroglycerin, the number of weekly angina episodes and the onset number of heart failure in the last year （r were 0. 67,0. 73 and 0. 73, P 〈 0. 05 ） . Conclusion DE-MRI can be used for evaluation and prediction of future cardiac events.