双能量CT心肌瘢痕量化预测陈旧性心肌梗死患者发生主要不良心血管事件风险

Quantification of myocardial scar by dual-energy CT predicts risk of major cardiovascular events in patients with old myocardial infarction

目的利用双能量CT(DECT)后处理技术检测心肌瘢痕特征,探讨其对陈旧性心肌梗死(OMI)患者1年内发生主要不良心血管事件(MACE)的预测价值。方法连续纳入2019年11月至2022年10月在南通大学第二附属医院行冠状动脉CT血管成像随后行DECT心肌碘延迟强化(LIE-DECT)的OMI患者。所有入组患者图像采用40 keV单能谱+(Mono+)进行重建,在左心室短轴位图上LIE(代表心肌瘢痕)进行量化,包括LIE节段数、LIE评分及LIE程度。所有入组患者进行MACE随访,MACE定义为心力衰竭住院、恶性心律失常、心源性死亡。用回归分析探讨DECT心肌瘢痕量化值与MACE发生的关系,受试者操作特征曲线(ROC)评估心肌瘢痕量化值的预测MACE的效能,并使用DeLong检验比较组间差异。结果最终纳入OMI患者231例,LIE-DECT检查后1年内发生MACE 37例,占16.0%。发生MACE组LIE节段数5(4,7)个、LIE评分27(13,49)分、LIE程度9.4%(7.5%,15.5%)均高于未发生MACE组3(2,5)个、9(6,15)分、6.7%(6.3%,7.9%),差异具有统计学意义(Z值分别为5.57、6.23、5.90,P均<0.001)。多因素logistic回归分析显示,调整混杂因素后,LIE节段数(OR=2.118,P<0.001)、LIE评分(OR=3.168,P<0.001)及LIE程度(OR=3.092,P<0.001)仍与MACE发生显著相关。ROC曲线分析显示,LIE节段数、LIE评分及LIE程度曲线下面积分别为0.715、0.822、0.806(P均<0.001),灵敏度分别为81.1%、86.5%、91.9%,特异度分别为53.6%、69.6%、60.8%。DeLong检验显示,LIE评分、LIE程度预测效能高于LIE节段数(Z=2.63,P=0.008;Z=1.96,P=0.049),LIE评分与LIE程度预测效能差异无统计学意义(Z=0.60,P=0.551)。结论LIE-DECT 40 keV Mono+图检测的LIE节段数、LIE评分及LIE程度是OMI患者发生MACE的危险因素,且具有很好的预测MACE发生的效能,可作为评估OMI临床预后的重要指标。

ObjectiveTo investigate the predictive value for major adverse cardiovascular events(MACE)occurring within 1 year in patients with old myocardial infarction(OMI)using characteristics of myocardial scar derive from dual-energy CT(DECT)post-processing technique.MethodsOMI patients who received coronary CT angiography following dual-energy CT with late iodine enhancement(LIE-DECT)in the Second Affiliated Hospital of Nantong University from November 2019 to October 2022 were continuously included,and the images of all enrolled patients were reconstructed using 40 keV monoenergetic plus(Mono+)map,LIE(representing myocardial scar)was quantified on left ventricular short-axis images,including the LIE segments,the LIE score,and the LIE degree.All enrolled patients were followed up for MACE,defined as hospitalization for heart failure,malignant arrhythmia,and cardiac death.Regression analysis was used to investigate the relationship between the quantified value of myocardial scar and the occurrence of MACE,and receiver operating characteristic curve(ROC)was used to evaluate the efficacy of quantified value of myocardial scar in predicting MACE.The area under the curve(AUC)was compared using the DeLong test.ResultsFinally,231 patients with OMI were included,and MACE occurred in 37 cases(16.0%)within 1 year after LIE-DECT examination.The LIE segments 5(4,7),the LIE score 27(13,49)and the LIE degree 9.4%(7.5%,15.5%)in the MACE group were higher than those in the non-MACE group 3(2,5),9(6,15)and 6.7%(6.3%,7.9%)(all P<0.001).Multivariable logistic regression analysis showed that after adjusting for confounders,the LIE segments(OR=2.118,P<0.001),the LIE score(OR=3.168,P<0.001),and the LIE degree(OR=3.092,P<0.001)remained risk factors for the development of MACE.On ROC analysis,AUC of LIE segments,LIE score and LIE degree were 0.715,0.822 and 0.806(all P<0.001),with sensitivities of 81.1%,86.5%,and 91.9%,and specificities of 53.6%,69.6%,and 60.8%,respectively.DeLong′s test showed that the predictive efficacy of LIE score and LIE degree was higher than that of LIE segments(Z=2.63,P=0.008;Z=1.96,P=0.049),and there were no significant differences in the predictive efficacy of LIE score and LIE degree(Z=0.60,P=0.551).ConclusionThe LIE segments,the LIE score and the LIE degree detected by LIE-DECT 40 keV Mono+maps are risk factors for the occurrence of MACE in patients with OMI and have good efficacy in predicting the occurrence of MACE,which can be used as important indicators for assessing the clinical prognosis of OMI.