冠状动脉慢性完全闭塞病变治疗后远期心脏磁共振右心室心肌应变的初步分析

Preliminary analysis of long-term right ventricular myocardial strain of coronary artery chronic total occlusion after treatment by cardiac magnetic resonance

目的应用心脏磁共振(CMR)特征追踪技术定量评估冠状动脉慢性完全闭塞病变(CTO)患者临床治疗后远期随访期间右心室功能及心肌应变的变化。方法纳入2015年1月至2019年12月于大连医科大学附属第一医院确诊为冠状动脉CTO并于治疗前后2次完成CMR检查的患者13例。采用CVI425.10软件测量左、右心室的结构和功能参数及右心室心肌应变参数,比较治疗前后各项参数的差异。结果13例患者2次CMR检查的间隔时间为259~1168 d,平均间隔时间为(500.08±228.34)d。就左心室参数而言,治疗后左心室舒张末期容积、左心室收缩末期容积均较治疗前增大,左心室质量较治疗前降低[148.35(141.70,181.66)mL vs 140.08(116.42,170.90)mL、77.78(52.41,100.24)mL vs 56.07(47.59,89.93)mL、(113.67±16.81)g vs(127.14±22.99)g,P均<0.05],其余左心室结构和功能参数在治疗前后比较差异均无统计学意义(P均>0.05)。就右心室参数而言,治疗后右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室质量(RVM)均较治疗前增大[(144.52±25.14)mL vs(118.46±28.08)mL、(71.51±14.59)mL vs(55.62±15.93)mL、(35.05±7.31)g vs(30.43±5.95)g,P均<0.05],右心室射血分数(RVEF)等右心室功能参数及各项心肌应变参数在治疗前后比较差异均无统计学意义(P均>0.05)。结论在治疗后远期随访期间,冠状动脉CTO患者的右心室功能参数RVEF及心肌应变保持稳定,但结构参数RVEDV、RVESV及RVM均增大。

Objective To quantitatively evaluate the changes of right ventricular function and myocardial strain in patients with coronary artery chronic total occlusion(CTO)during long-term follow-up after treatment by cardiac magnetic resonance(CMR).Methods A total of 13 patients who were diagnosed as coronary artery CTO in The First Affiliated Hospital of Dalian Medical University from Jan.2015 to Dec.2019 and completed CMR scanning before and after treatment were enrolled.The left and right ventricular structural and functional parameters as well as right ventricular myocardial strain parameters were measured by CVI425.10 software,and the differences of these parameters were analyzed before and after treatment.Results The interval between 2 CMR examinations was 259 to 1168 d in the patients,with an average of(500.08±228.34)d.In terms of left ventricular parameters,left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly increased after treatment,while left ventricular mass was significantly decreased(148.35[141.70,181.66]mL vs 140.08[116.42,170.90]mL,77.78[52.41,100.24]mL vs 56.07[47.59,89.93]mL,[113.67±16.81]g vs[127.14±22.99]g,all P<0.05);and there were no significant differences in other left ventricular structural or functional parameters before and after treatment(all P>0.05).In terms of right ventricular parameters,right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),and right ventricular mass(RVM)were significantly increased after treatment([144.52±25.14]mL vs[118.46±28.08]mL,[71.51±14.59]mL vs[55.62±15.93]mL,[35.05±7.31]g vs[30.43±5.95]g,all P<0.05);and there were no significant differences in right ventricular function parameters such as right ventricular ejection fraction(RVEF)or myocardial strain parameters(all P>0.05).Conclusion During long-term follow-up after treatment,the right ventricular functional parameter RVEF and myocardial strain of coronary artery CTO patients are stable,while the structural parameters RVEDV,RVESV and RVM are increased.