心脏磁共振下早期矛盾运动可多角度评估急性心肌梗死患者术后心功能状态

Early paradoxical motion under cardiac magnetic resonance can be used to evaluate postoperative cardiac function in patients with acute myocardial infarction from multiple angles

目的探讨心脏磁共振(CMR)早期矛盾运动与急性心肌梗死(AMI)患者临床特征、危险分层和临床预后的相关性。方法连续纳入2022年6月~2024年4月在我科住院并确诊的首发AMI患者77例,其中男性53例,女性24例,年龄61.75±11.92岁。所有患者均在入院后行罪犯血管血运重建术,并在术后平均1周内行CMR检查。根据心肌应变是否出现矛盾运动,将其分为矛盾运动组(n=47)和非矛盾运动组(n=30)。所有患者平均随访7月,统计主要不良心血管事件(MACEs)的发生。结果矛盾运动组患者的脑钠肽、中性粒细胞/淋巴细胞比值高于非矛盾运动组,淋巴细胞计数低于非矛盾运动组(P<0.05)。两组病变支数、罪犯血管、Gensini评分的差异无统计学意义(P>0.05)。CMR结果显示,矛盾运动组患者的梗死面积、左室收缩末期容积指数、微循环障碍容积高于非矛盾运动组(P<0.05),而左房射血分数、左室射血分数、梗死节段径向应变、梗死节段周向应变、梗死节段纵向应变、整体径向应变、整体周向应变、整体纵向应变均低于非矛盾运动组(P<0.05)。二元Logistic回归显示,中性粒细胞/淋巴细胞比值、梗死节段周向应变、整体纵向应变可以独立预测患者是否出现心肌矛盾运动。在矛盾运动组患者中,MACEs事件发生率高于非矛盾运动组(P<0.05),其中矛盾运动是AMI患者在接受成功血运重建后发生MACEs事件的独立危险因素(HR=2.551)。结论CMR可以多角度评估AMI术后心功能状态,为患者个体化治疗、改善临床预后提供了重要的参考依据。

Objective To explore correlations of early contradictory movements with clinical characteristics,risk stratification,and clinical prognosis in patients with acute myocardial infarction(AMI).Methods This study consecutively enrolled 77 firstonset AMI patients who were hospitalized and diagnosed in our department from June 2022 to April 2024,including 53 males and 24 females,with a mean age of 61.75±11.92 years.All patients underwent culprit-only revascularization after admission and received cardiac magnetic resonance(CMR)imaging within an average of one week after surgery.According to whether there were contradictory movements in myocardial strain,the included patients were divided into contradictory movement group(n=47)and non-contradictory movement group(n=30).All patients were followed up for an average of 7 months to record the occurrence of major adverse cardiovascular events(MACEs).Results Patients in the contradictory movement group had significantly increased brain natriuretic peptide levels and neutrophil/lymphocyte ratio,but decreased lymphocyte counts than those in the non-contradictory movement group(P<0.05).There was no significant difference in the number of diseased vessels,culprit vessels,and Gensini score between the contradictory movement group and the non-contradictory movement group(P>0.05).CMR results showed that patients in the contradictory movement group had significantly larger infarct areas visualized by LGE,higher left ventricular end-systolic volume index and microcirculation dysfunction volume than those in the non-contradictory movement group(P<0.05);while the former group had obviously lower left atrial ejection fraction,left ventricular ejection fraction,radial strain of the infarcted segment,circumferential strain of the infarcted segment,longitudinal strain of the infarcted segment,global radial strain,global circumferential strain,and global longitudinal strain than those in the latter group(P<0.05).Furthermore,binary logistic regression analysis showed that neutrophil/lymphocyte ratio,circumferential strain of the infarcted segment,and global longitudinal strain could predict whether patients had contradictory movements independently.In addition,the incidence of MACEs was significantly higher in the contradictory movement group than in the noncontradictory movement group(P<0.05),with contradictory movement being an independent risk factor for MACEs in AMI patients after successful revascularization(HR=2.551).Conclusion CMR can facilitate the evaluation of the postoperative cardiac function status of AMI patients from multiple perspectives,which may provide a valuable reference for applying personalized treatment and improving the clinical prognosis of patients.