超微血管成像联合CMR-FT在ACS患者微血管功能障碍评估中的应用

Application of superb microvasular imaging combined with CMR-FT for evaluation of microvascular dysfunction in patients with ACS

目的研究超微血管成像(SMI)联合心血管MRI特征追踪技术(CMR-FT)在急性冠状动脉综合征(ACS)患者微血管功能障碍评估中的应用。方法采用前瞻性分析,选择2017年8月至2020年11月在陕西中医药大学第二附属医院诊治的120例ACS患者(观察组),其中男性57例,女性63例;年龄51~84岁,平均年龄66.57岁;体质量指数24.11~25.09 kg/m^(2),平均体质量指数24.59 kg/m^(2);稳定心绞痛(SAP)49例,不稳定心绞痛(UAP)43例,急性心肌梗死(AMI)28例。另选取同期进行体检的健康人群120例(对照组),其中男性55例,女性65例;年龄50~82岁,平均年龄66.14岁;体质量指数24.11~25.09 kg/m^(2),平均体质量指数24.19 kg/m^(2)。比较两组患者的左心室的心肌应变力、心功能、冠状动脉斑块的影像学特征并进行分析;分析SMI联合CMR-FT诊断效能。结果观察组左心室整体峰值径向应变值(GPRS)[(24.89±8.24)%vs (44.26±9.19)%](t=17.191,P=0.000)、整体峰值周向应变值(GPCS)[(18.59±5.97)%vs (24.49±5.00)%](t=8.300,P=0.000)、整体峰值纵向应变值(GPLS)[(10.73±2.26)%vs (14.27±2.62)%](t=11.208,P=0.000)、节段峰值径向应变值(PRS)[(26.58±5.61)%vs (40.55±3.99)%](t=22.230,P=0.000)、节段峰值周向应变值(PCS)[(17.00±4.11)%vs (24.22±4.23)%](t=13.410,P=0.000)、节段峰值纵向应变值(PLS)[(10.54±0.64)%vs (15.36±0.97)%](t=45.435,P=0.000)显著低于对照组;观察组左心室收缩末期容积指数(LVESVi)[(79.96±2.12) mL/m^(2)vs (60.24±2.69) mL/m^(2)](t=63.072,P=0.000)、左心室舒张末期容积指数(LVEDVi)[(40.94±1.87) mL/m^(2)vs (19.62±1.72) mL/m^(2)](t=91.922,P=0.000)显著低于对照组;观察组动脉中层厚度(t=6.981,P=0.000)、斑块面积(t=53.118,P=0.000)及斑块数量(t=15.613,P=0.000)显著高于对照组;通过联合诊断效能分析,CMR-FT与SMI联合诊断对于冠状动脉微血管功能障碍的诊断特异度显著升高;通过受试者工作特性(ROC)曲线分析,联合诊断的曲线下面积显著高于单独检测。结论 SMI联合CMR-FT在ACS患者微血管功能障碍评估具有显著的意义,建议临床推广。

Objective To study the application of superb microvasular imaging(SMI) combined with cardiovascular magnetic resonance feature tracking technology(CMR-FT) for evaluation of microvascular dysfunction in patients with acute coronary syndrome(ACS). Methods From August 2017 to November 2020, 120 ACS patients were enrolled as observation group, which included 57 males and 63 females, aged 51-84 years old with mean age of 66.57 years old;body mass index(BMI) was 24.11-25.09 kg/m^(2) with mean BMI of 24.59 kg/m^(2);49 cases of stable angina pectoris(SAP), 43 of unstable angina pectoris(UAP) and28 of acute myocardial infarction(AMI). Meanwhile, 120 physical examination healthy were set as control group, which included55 males and 65 females, aged 50-82 years old with mean age of 66.14 years old;BMI was 24.11-25.09 kg/m^(2) with mean BMI of 24.19 kg/m^(2). The left ventricular myocardial strain, cardiac function and imaging characteristics of coronary artery plaque between 2 groups were compared and analyzed. The diagnostic efficacy of SMI combined with CMR-FT was analyzed.Results In observation group, the left ventricle global peak radial strain(GPRS)[(24.89 ± 8.24) % vs(44.26 ± 9.19) %](t = 17.191,P = 0.000), global peak circumferential strain(GPCS)[(18.59 ± 5.97) % vs(24.49 ± 5.00) %](t = 8.300, P = 0.000), global peak longitudinal strain(GPLS)[(10.73 ± 2.26) % vs(14.27 ± 2.62) %](t = 11.208, P = 0.000), peak radial strain(PRS)[(26.58 ± 5.61) %vs(40.55 ± 3.99) %](t = 22.230, P = 0.000), peak circumferential strain(PCS)[(17.00 ± 4.11) % vs(24.22 ± 4.23) %](t =13.410, P = 0.000), peak longitudinal strain(PLS)[(10.54 ± 0.64) % vs(15.36 ± 0.97) %](t = 45.435, P = 0.000) were significantly lower than those in control group;the left ventricular endsystolic volume index(LVESVi)[(79.96 ± 2.12) mL/m^(2) vs(60.24 ±2.69) mL/m^(2)](t = 63.072, P = 0.000), left ventricular end-diastolic volume index(LVEDVi)[(40.94 ± 1.87) mL/m^(2) vs(19.62 ±1.72) mL/m^(2)](t = 91.922, P = 0.000) were significantly lower than those in control group;medial arterial thickness(t = 6.981, P =0.000), plaque area(t = 53.118, P = 0.000) and plaque number(t = 15.613, P = 0.000) were significantly higher than those in control group. The combined diagnosis performance analysis indicated that the diagnosis specificity of CMR-FT combined with SMI in diagnosis of coronary microvascular dysfunction was significantly increased. The receiver operating characteristic(ROC)curve analysis showed that the area under curve of combined diagnosis was significantly higher than that of single detection.Conclusion It is demonstrated that SMI combined with CMR-FT showed significance in evaluation of microvascular dysfunction in ACS patient, which is recommended to be promoted in clinic.