心脏磁共振组织追踪技术与超声心动图评估冠心病心肌梗死的诊断价值

Diagnostic Value of CMR-TT and Echocardiography in Patients with Myocardial Infarction of Coronary Heart Disease

目的探究心脏磁共振组织追踪(Cardiovascular Magnetic Resonance Tissue Tracking,CMR-TT)技术与超声心动图对冠心病心肌梗死的诊断价值。方法回顾性选取2020年6月至2022年12月收治的82例冠心病患者作为研究对象(冠心病组),另选取50例同期来院进行健康体检的志愿者作为对照组,所有研究对象均行彩色多普勒超声心动图及CMRTT检查。观察82例冠心病患者超声心动图诊断结果,对比冠心病组与对照组在左心室功能指标[左心室射血分数(Left Ventricular Ejection Fraction,LVEF)、左心室舒张末期容积(Left Ventricular End-Diastolic Volume,LVEDV)、左心室收缩末期容积(Left Ventricular End-Systolic Volume,LVESV)]及心肌应变参数(径向应变、周向应变、纵向应变)方面的差异,比较冠心病患者延迟钆增强(Late Gadolinium Enhancement,LGE)阳性及阴性心肌节段的心肌应变参数。通过受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析各指标参数对于心肌节段梗死的诊断价值。结果彩色多普勒超声心动图检查心肌梗死的敏感度为89.19%;冠心病组患者LVEF水平低于对照组,LVEDV及LVESV水平高于对照组(P<0.05);超声心动图ROC曲线结果显示,LVEF、LVEDV、LVESV诊断心肌节段梗死的敏感度依次为89.0%、50.0%、73.2%,特异性依次为92.0%、100.0%、90.0%(P<0.05)。冠心病组患者径向应变显著低于对照组,周向应变及纵向应变显著高于对照组(P<0.05);LGE阳性心肌节段径向应变显著低于LGE阴性心肌节段,周向应变及纵向应变显著高于LGE阴性心肌节段(P<0.05);CMR-TT的ROC曲线结果显示,径向应变、周向应变、纵向应变诊断心肌节段梗死的敏感度依次为90.8%、90.1%、95.8%,特异性依次为100.0%、100.0%、90.9%(P<0.05)。结论冠心病患者存在左心室功能及心肌应变参数异常现象,超声心动图及CMR-TT技术均对于诊断冠心病患者心肌梗死具有较好的准确性,但CMR-TT技术各项诊断价值更高,值得临床参考。

Objective To explore the diagnostic value of cardiovascular magnetic resonance tissue tracking(CMR-TT)technology and echocardiography in patients with myocardial infarction of coronary heart disease.Methods A total of 82 patients with coronary heart disease admitted from June 2020 to December 2022 were retrospectively selected as the research subjects(coronary heart disease group),and 50 volunteers who came to the hospital for health examination at the same time were selected as the control group.All research subjects were examined by color Doppler echocardiography and CMR-TT.The echocardiography diagnosis results of 82 patients with coronary heart disease were observed,the differences in left ventricular function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)],myocardial strain parameters(radial strain,circumferential strain,longitudinal strain)between the coronary heart disease group and the control group were compared,and the myocardial strain parameters of positive and negative segments of late gadolinium enhancement(LGE)in patients with coronary heart disease were compared.The diagnostic value of parameters in myocardial segmental infarction was analyzed by receiver operating characteristic(ROC)curve.Results The sensitivity of color Doppler echocardiography in detecting myocardial infarction was 89.19%;the LVEF level of patients in coronary heart disease group was significantly lower than that in the control group,LVEDV and LVESV levels were significantly higher than that in the control group(P<0.05);the ROC curve of echocardiography showed that the sensitivity of LVEF,LVEDV and LVESV in diagnosing myocardial segmental infarction was 89.0%,50.0%and 73.2%,and the specificity was 92.0%,100.0%and 90.0%,respectively(P<0.05).The radial strain of patients in coronary heart disease group was significantly lower than that in the control group,and the circumferential strain and longitudinal strain were significantly higher than that in the control group(P<0.05);the radial strain of LGE positive myocardial segment was significantly lower than LGE negative myocardial segment,and the circumferential strain and longitudinal strain were significantly higher than LGE negative myocardial segment(P<0.05);the CMR-TT ROC curve showed that the sensitivity of radial strain,circumferential strain and longitudinal strain in diagnosing myocardial segmental infarction was 90.8%,90.1%and 95.8%,and the specificity was 100.0%,100.0%and 90.9%,respectively(P<0.05).Conclusion There are abnormalities in left ventricular function and myocardial strain parameters in patients with coronary heart disease.Echocardiography and CMR-TT technology both have good accuracy in diagnosing myocardial infarction in patients with coronary heart disease,but CMR-TT technology has higher diagnostic value and is worthy of clinical reference.