急性病毒性心肌炎心脏磁共振心肌首过灌注及与cTnT的相关性

First-pass perfusion of CMR and cTnT in patients with acute viral myocarditis

目的:应用心脏磁共振心肌首过灌注技术(CMR-MPI)对急性病毒性心肌炎(AVM)进行定量分析,并获得灌注曲线下面积比与肌钙蛋白(cTn)T的关系。方法:纳入31例AVM患者(AVM组)与20例健康志愿者(对照组)。两组行3.0T心脏磁共振扫描,测定CMR-MPI灌注参数(曲线下面积比、达峰时间及相对峰值信号)和cTnT浓度。采用Spearman等级相关对CMR-MPI曲线下面积和血清cTnT浓度进行统计分析。结果:曲线下面积比:灌注正常区、减低区及缺损区分别为(52.80±3.05)%、(37.64±4.87)%、(26.23±2.29)%,P<0.05;相对峰值信号强度分别为(44.91±3.16)%、(33.96±4.98)%、(29.94±3.75)%,P<0.05;达峰时间分别为(34.22±4.89)s、(37.85±7.51)s、(38.24±6.06)s,P<0.05。AVM组与对照组血清cTnT浓度分别为(0.578±1.127)ng/ml、(0.011±0.006)ng/ml,P<0.05。Spearman等级相关分析AVM组CMR-MPI曲线下面积比与血清cTnT浓度的关系,rs=-0.557,P<0.05。结论:CMR-MPI可定量评估AVM心肌缺血程度,AVM患者血清cTnT浓度与CMR-MPI曲线下面积比呈负相关,提示AVM心肌微循环障碍和心肌缺血可能是造成或加重心肌细胞损伤及cTnT释放的原因之一。

Objective：To quantitatively analyze acute viral myocarditis（AVM）by first-pass cardiovascular magnetic resonance myocardial perfusion imaging（CMR-MPI）,and obtain the relationship between area ratio under the perfusion curve and cTnT.Method：The 31 patients with AVM（AVM group）and 20 healthy volunteers（control group）were enrolled in this research and determined CMR-MPI perfusion parameters（area ratio under the curve,peak time and relative peak signal）by 3.0Tcardiac magnetic resonance scanning.Serum cTnT concentration was detected.Statistical analysis of the area under the CMR-MPI curve and serum cTnT was performed by Spearman rank method.Result：Ratios of area under the curve were（52.80±3.05）%,（37.64±4.87）% and（26.23±2.29）%in the normal perfusion zone,reduced perfusion zone and perfusion defect zone respectively,P〈0.05;Relative peak signals were（44.91±3.16）%,（33.96±4.98）% and（29.94±3.75）%respectively,P〈0.05.Peak times were（34.22±4.89）s,（37.85±7.51）s and（38.24±6.06）s,respectively,P〈0.05.Serum cTnT concentration were（0.578±1.127）ng/mL and（0.011±0.006）ng/mL in AVM group and control group respectively,P〈0.05.Spearman rank correlation showed that the area under the CMR-MPI curve was negatively related to serum cTnT,rs=-0.557,P〈0.05.Conclusion：CMR-MPI can quantitatively assess the degree of myocardial ischemia in AVM.The serum cTnT concentration of AVM patients was negatively correlated with the area under CMR-MPI curve.