急性ST段抬高型心肌梗死合并高血压患者的CMRI心外膜脂肪分析

Cardiac magnetic resonance imaging of epicardial adipose tissue in patients with acute ST-segment elevation myocardial infarction complicated by hypertension

目的心外膜脂肪(EAT)与冠状动脉粥样硬化性心脏病(冠心病)以及高血压关系密切,心脏磁共振成像(CMRI)已成熟运用到心肌梗死人群的评估当中,本研究采用CMRI探讨急性ST段抬高型心肌梗死(STEMI)合并高血压患者的心外膜脂肪差异。方法本研究为一项回顾性研究,连续选取2019年1月至2021年12月于徐州医科大学附属医院CCU科室急诊经皮冠状动脉介入治疗(PCI)术后行CMRI的320例STEMI患者,经排除后最终纳入304例患者,根据是否合并高血压分为STEMI无高血压组(n=171),STEMI合并高血压组(n=133),比较两者的EAT。结果与STEMI无高血压组相比,STEMI合并高血压患者的EAT体积[EATV,(157.23±14.61)ml vs.(143.64±15.99)ml,P<0.01]和EAT质量[EATM,(161.33±15.1)g vs.(147.26±17.34)g,P<0.01]增高。多因素Logistic回归分析显示EATV(OR=1.064,95%CI:1.039~1.086,P<0.01),EATM(OR=1.069,95%CI:1.032~1.084,P<0.01)是STEMI合并高血压患者的独立危险因素(P<0.05)。ROC曲线分析显示EATV最佳截断值为151.3 ml,曲线下面积为0.779(95%CI:0.725~0.834,P<0.01);EATM最佳截断值为155.35g,曲线下面积为0.791(95%CI:0.738~0.844,P<0.01)。结论EATV与EATM是STEMI合并高血压患者的独立危险因素,且具有较好的预测价值。

Objective Epicardial adipose tissue(EAT)is closely related to coronary artery disease(CHD)and hypertension,and cardiac magnetic resonance imaging(CMRI)has been maturely applied in the assessment of myocardial infarction(MI).To discuss the difference in EAT by using CMRI in patients with STsegment elevation myocardial infarction(STEMI)complicated by hypertension(HTN).Methods STEMI patients undergoneemergencypercutaneous coronary intervention(PCI)and CMRI(n=320)were chosen from Critical Care Unit in Affiliated Hospital of Xuzhou Medical University from Jan.2019 to Dec.2021.After exclusion,304 patients were divided into STEMI+non-HTN group(n=171)and STEMI+HTN group(n=133).The EAT volume(EATV)and EAT mass(EATM)were compared between 2 groups.Results EATV[(157.23±14.61)ml vs.(143.64±15.99)ml,P<0.01]and EATM[(161.33±15.1)g vs.(147.26±17.34)g,P<0.01]increased in STEMI+HTN group compared with STEMI+non-HTN group.The results of multi-factor Logistic regression analysis showed that EATV(OR=1.064,95%CI:1.039~1.086,P<0.01)and EATM(OR=1.069,95%CI:1.032~1.084,P<0.01)were independent risk factors in STEMI complicated by HTN(P<0.05).The results of ROC curve analysis showed that the optimal cutoff value of EATV was 151.3 ml,AUC was 0.779(95%CI:0.725~0.834,P<0.01),and the optimal cutoff value of EATM was 155.35 g and AUC was 0.791(95%CI:0.738~0.844,P<0.01).Conclusion EATV and EATM are independent risk factors in STEMI patients complicated by HTN,and they have a higher predictive value.