心脏MR在冠状动脉非阻塞性肌钙蛋白升高中的诊断价值

Application of cardiac magnetic resonance imaging in diagnosing troponin increase with non-obstructive coronary arteries

目的探讨心脏MR(CMR)多参数成像技术对冠状动脉非阻塞性肌钙蛋白升高(TINOCA)潜在病因诊断及鉴别诊断价值。方法回顾性分析东莞康华医院2018年1月至2023年6月,所有经冠状动脉造影证实的TINOCA患者33例,于发病7 d内进行CMR检查,检查序列包括黑血成像、亮血电影、黑血T_(2)加权脂肪抑制序列、横向弛豫时间定量序列、心肌首过灌注及延迟钆增强(LGE)。根据影像学表现将入选病例分为冠状动脉非阻塞性心肌梗死(MINOCA)组、急性心肌炎组、Takotsubo综合征组及CMR阴性组。观察指标为左心室功能、心肌水肿情况、首过灌注及LGE改变。对不同病变的差异进行统计学分析,计数资料采用卡方检验或Fisher确切概率法进行组间分析;符合正态分布的计量资料,采用x±s进行统计描述,两样本均数的比较采取独立样本t检验;偏态分布的计量资料采用M(Q_(1),Q_(3))进行统计描述,采用Mann-Whitney秩和检验进行组间分析。结果33例患者中CMR诊断为MINOCA组14例(42.4%)、急性心肌炎12例(36.4%)、Takotsubo综合征组0例、CMR阴性组7例(21.2%),CMR诊断阳性率78.8%。MINOCA与急性心肌炎组相比,发病年龄差异具有统计学意义(Z=3.32,P=0.001),左心功能、心肌水肿节段数及病变心肌T 2值差异无统计学意义(P>0.05),二者首过灌注异常例数差异具有统计学意义(P<0.001),LGE质量、体积差异均具有统计学意义(P均<0.05)。结论CMR多参数成像技术在TINOCA病因诊断中具有独特作用,能对MINOCA、急性心肌炎等心源性病因引起的TINOCA作出准确鉴别。

ObjectiveTo investigate the utility of cardiac magnetic resonance(CMR)multiparametric imaging in the etiological and differential diagnoses of troponin increase with non-obstructive coronary arteries(TINOCA).MethodsA retrospective analysis was conducted on patients diagnosed with TINOCA and confirmed by coronary angiography in Dongguan Kanghua Hospital from January 2018 to June 2023.CMR examinations were performed within 7 days of onset.The examination sequences included"black blood"single-shot balanced turbo field echo with breath-hold,balanced turbo field echo with breath-hold,T 2-weighted short tau inversion recovery black blood,modified gradient and spin echo black blood with SENSE,dynamic balanced turbo field echo,and phase-sensitive inversion recovery[late gadolinium enhancement(LGE)].Based on the imaging findings,patients were categorized into 4 groups:myocardial infarction with non-obstructive coronary arteries(MINOCA)group,acute myocarditis group,Takotsubo syndrome group,and CMR negative group.The observed indices included left ventricular function,myocardial edema,first perfusion,and LGE of contrast enhancement.The differences in these parameters among the aforementioned disease groups were statistically compared.The categorical data were analyzed between groups using the chi-square test or Fisher′s exact probability method.The data in line with normal distribution were statistically described by x±s.The independent-sample t test was used to compare the means of the 2 samples.The data with skewed distribution were described by M(Q 1,Q 3).The Mann-Whitney U test was used for intergroup analysis.ResultsA total of 33 patients were enrolled in this study,the 4 groups comprised 14(42.4%),12(36.4%),0,and 7(21.2%)patients,respectively.The positive rate of CMR diagnosis was 78.8%.The onset age in the MINOCA group significantly differed from that in the acute myocarditis group(Z=3.32,P=0.001).No significant differences were observed in left ventricular function,number of myocardial edema segments,and T 2 value of the diseased myocardium between the 2 groups(P>0.05),but the number of abnormal first perfusion was significantly distinct(P<0.001).Significant differences were observed in the quality and volume of LGE between the 2 groups(P<0.05 for all).ConclusionCMR multiparameteric imaging technology plays a unique role in the etiological diagnosis of TINOCA,accurately distinguishing TINOCA caused by MINOCA,acute myocarditis,and other cardiac causes.