心脏核磁共振成像对缺血后处理急性 ST 段抬高型心肌梗死后心室重塑的影响

Influence of cardiac magnetic resonance imaging on the ventricular remodeling after ischemic post-conditioning ST-segment elevation myocardial infarction

  • 摘要: 目的:探讨心脏核磁共振成像(CMR)对缺血后处理急性 ST 段抬高型心肌梗死(STEMI)后心室重塑的影响。方法选择32例12 h 内行缺血后处理的 STEMI 患者作为实验组及12例健康志愿者作为对照组。2组均于术后6个月行 CMR检查,测量左室心功能指标及梗死心肌面积所占百分比,并以24%为分界值,将实验组又分为无重塑组和重塑组。分析各组间的心功能参数差异,并进行受试者工作特征(ROC)分析。结果与对照组比较,无重塑组与重塑组患者的舒张末期容积(EDV)、收缩末期容积(ESV)和每搏输出量(SV)均明显增加,而射血分数(EF)、PER 和 PFR 均有不同程度的下降,其中重塑组下降的幅度更为显著。ESV 与 EDV 的增大呈线性关系;PFR、PER 和 EF 均随 EDV 的增大而呈线性下降趋势。ROC 分析结果显示,EDV、ESV、EF 和 PFR 的曲线下面积分别为0.741、0.764、0.713和0.743。结论CMR 对预测心室重塑有重要作用,其中 PFR、ESV 和 EDV 可作为独立因子预测心室重塑。

     

    Abstract: Objective To explore the influence of cardiac magnetic resonance imaging (MRI)on the ventricular remodeling after ischemic post-conditioning ST-segment elevation myocardial infarction (STEMI).Methods 32 STEMI patients treated with ischemic post-conditioning in 12 hours were designed as experimental group,and 12 healthy volunteers were designed as control group.The patients in both groups were given CMR 6 months after surgery,and the left ventricular functional in-dexes and percentage of infarction size were measured.With 24% as the limit value,the experiment group was divided into remodeling and non-remodeling groups.Differences of cardiac functional param-eters and receiver operating characteristic (ROC)were analyzed among groups.Results Compared with control group,end-diastolic volume (EDV),end-systolic volume (ESV)and stroke volume (SV)in remodeling and non-remodeling groups increased significantly,whereas ejection fraction (EF),PER and PFR decreased by varying degrees,in which the decreasing range was even more sig-nificant in remodeling group.There was a linear relationship between ESV and EDV increase,and with increasing of EDV,PFR,PER and EF showed a linear diminishing trend.ROC results revealed that the areas under the curve of EDV,ESV,EF and PFR were 0.741,0.764,0.713 and 0.743, respectively.Conclusion CMR plays a key role in the prediction of ventricular remodeling,in which PFR,ESV and EDV can be used as independent factors to predict ventricular remodeling.

     

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