心肌梗死患者合并不同分级二尖瓣反流的影响因素

Influencing Factors of Mitral Regurgitation After Myocardial Infarction

目的 心肌梗死(MI)后二尖瓣反流可导致患者不可逆的充血性心力衰竭及长期死亡风险的显著增加,特别是二尖瓣中重度反流的患者,因此确定MI患者二尖瓣反流的影响因素具有重要临床意义。本研究基于心脏磁共振(CMR)探讨包括左心室应变在内的左室结构功能参数及梗死容积对MI患者合并二尖瓣反流的影响因素。方法 回顾性搜集2015年7月至2023年3月间在昆明医科大学第二附属医院经临床及CMR确诊的陈旧性MI患者,根据超声心动图结果将患者分为无反流组、轻度反流组及中重度反流组。通过CMR后处理软件CVI42获得左室功能容积指标和心肌梗死特征参数,包括整体纵向应变(GLS)、整体周向应变(GCS)、整体径向应变(GRS)、左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、梗死容积。采用单因素方差分析、卡方检验及秩和检验进行三组间临床基线资料及CMR参数差异性分析,进一步行Logistic回归分析MI患者二尖瓣反流不同分级的影响因素。结果 共纳入MI患者126例,无反流组36例,轻度反流组59例,中重度反流组31例。三组患者GLS、GCS、GRS、LVEF、LVEDVI、LVESVI有显著统计学差异(P<0.05),梗死容积无显著统计学意义(P>0.05)。多因素有序Logistic回归分析显示,GCS及LVESVI为MI后二尖瓣反流不同分级的影响因素(均P<0.05)。结论 基于CMR-FT量化评估的左心室应变结合容积参数LVESVI可有效反映MI后左室重构对二尖瓣反流的影响,GCS与二尖瓣反流程度呈负相关,LVESVI与二尖瓣反流程度呈正相关。

Objective Mitral regurgitation after myocardial infarction(MI)leads to a significant increase in the risk of irreversible congestive heart failure and long-term mortality in patients,especially in those with moderate to severe mitral regurgitation,thus determining the predictors of mitral regurgitation in MI patients is of great clinical value.The purpose of this study is to explore the influencing factors of mitral regurgitation after myocardial infarction with cardiovascular magnetic resonance(CMR).Methods Between July 2015 and March 2023,MI patients at admission were included in this study.Ac-cording to the follow-up results,the study populationts were divided into non-mitral regurgitation group,mild mitral regurgitation group and moderate to severe mitral regurgitation group.CMR parameters,including global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),and infarction volume,were obtained by software CVI 42.Multivariate analyses were performed to identify influencing factors in the development of mitral regurgitation.Results A total of 112 participants,36 in non-mitral regurgitation group,59 in mild mitral regurgitation group and 31moderate to severe mitral regurgitation group were included.There were significant differences between the GLS、GCS、GRS、LVEF、LVEDVI、LVESVI(P<0.05)among three groups,while there was no significant differences in infarction volume among three groups.Multivariate logistic regression analysis showed that GCS and LVESVI were influencing factors of mitral regurgitation after MI(P<0.05).Conclusion The LV strain combined with LVESVI can effectively reflect the effect of LV remodeling on mitral regurgitation after MI.