磁共振对急性ST段抬高型心肌梗死介入术后左心功能改善的预测价值

Predictive value of MRI for cardiac function improvement after intervention in acute myocardial infarction patients

目的探讨心脏磁共振(cardiac magnetic resonance,CMR)多参数对ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后心功能恢复不良的预测价值。材料与方法回顾性分析52例初次诊断为STEMI于急诊行PCI患者资料,且术后1周内CMR提示左心室射血分数(left ventricle ejection fraction,LVEF)<50%。术后3~4个月复查CMR,根据其LVEF分为心功能未恢复组(LVEF<50%)和心功能恢复组(LVEF≥50%)。对比两组患者临床资料和两次CMR参数,回归模型分析CMR参数对患者短期心功能恢复的预测价值。结果本研究STEMI急诊PCI术后心功能不全者中50%患者短期内心功能恢复。心功能未恢复组PCI术后48 h内超敏肌钙蛋白T水平、肌酸激酶同工酶水平、急性期心肌梗死面积、透壁程度和微血管阻塞均高于心功能恢复组(P<0.05)。Logistic回归分析显示,年龄≥60岁(P=0.017,OR=7.053,95%CI:1.413~35.211)和透壁性心肌梗死(P=0.040,OR=5.913,95%CI:1.065~32.835)是预测心功能恢复不良的独立影响因素。结论年龄≥60岁和急性透壁性心肌梗死是STEMI患者PCI术后心功能不全者短期心功能恢复不良的独立预测因素。

Objective:To investigate the prognostic value of cardiac magnetic resonance multiparameter in patients with acute ST segment elevation myocardial infarction(STEMI)underwent primary percutaneous coronary intervention(PCI).Materials and Methods:STEMI patients who underwent emergency PCI in the Affiliated Hospital of Xuzhou Medical University from Sep 2019 to Mar 2021 were retrospective analyzed,and CMR examination was performed within 1 week after surgery,52 patients with left ventricular ejection fraction(LVEF)<50%were selected.The 52 patients underwent CMR examination again 3-4 months after PCI,and were divided into LVEF<50%group and LVEF≥50%group according to follow-up LVEF.Clinical data and all CMR parameters(LVEF,myocardial infarction size,transmurality,microcirculation obstruction)were compared between the two groups,and Logistic regression model was used to analyze the predictive value of CMR parameters on cardiac function recovery after PCI in acute STEM patients.Results:In this study,50%of the patients with cardiac dysfunction after STEMI emergency PCI recovered short-term cardiac function.In LVEF<50%group,the level of hypersensitive troponin T level and creatine kinase within 48 hours after PCI,infarct size,transmurality and microvascular obstruction(MVO)in the baseline CMR were all higher than those in LVEF≥50%group.P values were all<0.05.Logistic regression analysis showed that age≥60(P=0.017,OR=7.053,95%CI:1.413-35.211)and transmural myocardial infarction(P=0.040,OR=5.913,95%CI:1.065-32.835)were independent factors for predicting poor cardiac function recovery.Conclusions:The elderly and acute transmural myocardial infarction are independent predictors of poor short-term cardiac function recovery in STEMI patients with cardiac dysfunction after PCI.