摘要： 目的·应用心脏磁共振（cardiac magnetic resonance，CMR）技术，探究ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者微血管阻塞（microvascular obstruction，MVO）对左室功能及预后的影响。方法·纳入2016年1月—2017年12月于上海交通大学医学院附属仁济医院心内科就诊的STEMI患者124例，应用CMR技术评估患者再灌注后心肌梗死百分比、心肌MVO百分比及左室功能。依据心肌MVO百分比，将患者分为MVO（+）组和MVO（-）组，比较2组的基线特征、血生化指标和CMR指标。MVO（+）组依据心肌梗死百分比的四分位数进一步分为4个亚组，利用Pearson相关分析探究各亚组患者心肌MVO百分比与左室射血分数（left ventricular ejection fraction，LVEF）的相关性。随访所有患者30 d内不良事件的发生情况，采用受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）分析心肌MVO百分比对不良事件的预测价值。结果·在基线特征无明显差异的情况下，MVO（+）组的白细胞计数、血清磷酸肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白I、总胆固醇水平均高于MVO（-）组（均
P<0.05）。MVO（+）组的LVEF低于MVO（-）组（
P=0.000）。Pearson相关分析显示，心肌MVO百分比与LVEF呈负相关（均
P<0.05）。ROC曲线显示，心肌MVO百分比预测患者30 d内不良事件的曲线下面积为0.889（95%
CI 0.823~0.975），其敏感度和特异度均高于心肌梗死百分比。结论·合并MVO的STEMI患者的左室功能及预后更差，提示需更加重视对于此类患者的临床干预。
关键词: 心脏磁共振, ST段抬高型心肌梗死, 微血管阻塞, 左室功能, 预后 Abstract: Objective·To investigate the effect of microvascular obstruction (MVO) on left ventricle function and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) by using cardiac magnetic resonance (CMR) technique.
Methods·A total of 124 patients with STEMI in the Department of Cardiology of Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to December 2017 were enrolled. The percentage of myocardial infarction size, the percentage of myocardial MVO size and left ventricle function after reperfusion were evaluated by CMR technique. According to the percentage of myocardial MVO size, the patients were divided into MVO (+) group and MVO (-) group. The baseline characteristics, blood biochemical indexes and CMR indexes of the two groups were compared. The MVO (+) group was further divided into 4 subgroups according to the quartiles of the percentage of myocardial infarction size. Pearson correlation analysis was used to explore the correlation between the percentage of myocardial MVO size and left ventricular ejection fractions (LVEF) in each subgroup. The incidence of adverse events within 30 days was observed. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of the percentage of myocardial MVO size for adverse events.
Results·The white blood cell count, creatine phosphokinase, creatine kinase MB, cardiac troponin I and total cholesterol in the MVO (+) group were significantly higher than those in the MVO (-) group (all P<0.05), while baseline characteristics showed no significant difference. LVEF in the MVO (+) group was lower than that in the MVO (-) group (P=0.000). Pearson correlation analysis showed that the percentage of myocardial MVO size was negatively correlated with LVEF (all P<0.05). ROC curve showed that the area under the curve of the percentage of myocardial MVO size in the prediction of adverse events within 30 days was 0.889 (95%CI 0.823?0.975), and the sensitivity and specificity of the percentage of myocardial MVO size were more higher than that of the percentage of myocardial infarction size.
Conclusion·The left ventricle function and prognosis in STEMI patients with MVO are worse, suggesting that more attention should be paid to the clinical intervention for such patients.
Key words: cardiac magnetic resonance (CMR), ST-segment elevation myocardial infarction (STEMI), microvascular obstruction (MVO), left ventricle function, prognosis PDF全文下载地址:
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