心脏MR纵向弛豫时间定量成像评估新型冠状病毒肺炎康复患者心肌损伤的价值

Application value of cardiovascular MR T1 mapping in patients recovered from COVID-19

目的探讨心脏MR(CMR)纵向弛豫时间定量成像(T1 mapping)评估新型冠状病毒肺炎(COVID-19)康复者心肌损伤的价值。方法前瞻性收集阜阳市第二人民医院2020年5月至6月COVID-19患者康复出院3个月后接受CMR检查的15例患者(9例普通型、6例重型)的临床及影像资料。另外选取11名健康志愿者的CMR资料作为对照组。CMR扫描序列包括心脏电影、对比增强前后T1 mapping成像、钆延迟对比增强成像(LGE),测量心功能参数、左心室心肌初始T1值及心肌细胞外容积分数(ECV)。采用单因素方差分析比较3组间参数值的差异,进一步两两比较采用LSD-t法。结果15例COVID-19康复患者LGE均为阴性,普通型(27.9%±2.7%)和重型康复者(30.0%±3.7%)左心室ECV均高于对照组(23.2%±1.9%),差异有统计学意义(P<0.05),普通型与重型康复者左心室ECV差异无统计学意义(P=0.100)。普通型康复者、重型康复者及对照组左心室初始T1值及其余左心室、右心室形态及功能的参数差异均无统计学意义(P>0.05)。结论CMR纵向弛豫时间定量成像的左心室ECV在COVID-19康复者中升高,提示可能存在潜在的心肌损伤。

Objective To explore the value of cardiovascular MR(CMR)T1 mapping in evaluating myocardial injury in patients recovered from COVID-19.Methods The clinical and image data of 15 patients with COVID-19(9 with moderate clinical manifestation,6 with severe clinical manifestation)who underwent CMR screening at 3 months after being discharged from the Second People′s Hospital of Fuyang City during May 2020 to June 2020 were prospective collected.Fifteen COVID-19 patients were selected as case group,and another 11 healthy volunteers were selected as control group.A standardized CMR protocol included cine,native and enhanced T1 mapping,late gadolinium enhancement(LGE).Cardiac functional parameters,native T1 value of left ventricular and extracellular volume fraction(ECV)were measured.One way ANOVA was used to assess the difference between CMR parameters among moderate and severe manifestation groups and control group,and LSD-t was used to assess the difference between the three groups.Results LGE value was negative in all subjects.ECV values were higher in recovered COVID-19 patients with either moderate(27.9%±2.7%)or severe manifestation(30.0%±3.7%)than control group(23.2±1.9%)(P<0.05);there was no significant difference of ECV values between recovered COVID-19 patients with moderate and severe manifestation(P=0.100).There was no difference of native T1 values and other functional and morphologic parameters of left ventricular and right ventricular among recovered COVID-19 patients with moderate and severe manifestation and control group(P>0.05).Conclusion CMR myocardial tissue ECV increase in patients who recovered from COVID-19,suggesting subclinical myocardial injury.