心脏磁共振获取的细胞外容积(ECV)与微循环障碍(MVO)有关

Relationship between extracellular volume acquired by cardiac magnetic resonance and microvascular obstruction

目的探讨在诊断为急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后,在心脏磁共振(Cardiac Magnetic Resonance,CMR)图像上的细胞外容积(Extracellular Volume,ECV)与微循环障碍(MVO)的关系。方法回顾性连续选择于2022年1月至2023年10月因STEMI就诊并行CMR检查及PCI的患者308例,根据患者磁共振图像是否存在明显MVO分为MVO组及对照组,比较两组的临床基线资料。采用单因素及多因素Logistic回归分析研究STEMI患者PCI术后MVO发生的影响因素,并绘制相关ROC曲线以研究ECV、超敏肌钙蛋白T(hs-TnT)峰值、TIMI血流分级以及左室射血分数(LVEF)对PCI后是否发生MVO的预测价值。结果TIMI血流分级、N末端脑钠肽前体(NT-proBNP)峰值、hs-TnT峰值、LVEF及心肌梗死部位ECV提示是MVO独立危险因素(P<0.01)。ECV预测MVO的ROC曲线下面积(AUC)为0.687(95%CI:0.628~0.746,P<0.001),敏感度为84.9%,特异性为49.4%。且与低ECV组相比,高ECV组患者的hs-TnT更高,LVEF更低(P<0.01)。结论梗死部位的ECV是MVO的独立危险因素。

Objective To investigate the relationship between extracellular volume(ECV)acquired by cardiac magnetic resonance(CMR)and microvascular obstruction(MVO)in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods STEMI patients undergone CMR examination and PCI(n=308)were retrospectively chosen from Jan.2022 to Oct.2023.All patients were divided,according to whether they had MVO,into MVO group and control group.The clinical baseline materials were compared between 2 groups.The influence factors for MVO were studied by using single-factor and multi-factor Logistic regression analyses in STEMI after PCI.The relevant ROC curve was drawn for studying the predictive value of ECV,high sensitivity cardiac troponin T(hs-cTnT),TIMIflow grades and left ventricular ejection fraction(LVEF)to MVO occurrence after PCI.According to ECVcutoff value by ROC curve analysis,the patients were divided into low-ECV group and high-ECV group.Results TIMIflow grades,peak value of N-terminal pro-brain natriuretic peptide(NT-proBNP)and hs-cTnT,LVEF and ECV at siteof myocardial infarction were independent risk factors for MVO(P<0.01).In prediction of MVO by ECV,AUC of ROC curve was 0.687(95%CI:0.628~0.746,P<0.001),sensitivity was 84.9%and specificity was 49.4%.The level of hs-cTnT was higher and LVEF was lower in high-ECV group than those in low-ECV group(P<0.01).Conclusion ECV at site of myocardial infarction is an independent risk factor for MVO occurrence.