| 摘要: |
| 目的 探讨ST段抬高型心肌梗死（STEMI）后超声心动图无创评估心肌做功与心脏磁共振钆延迟增强扫描（LGE-CMR）评估心肌活力的相关性，以及心肌梗死核心区与远离区在心肌做功参数上的差异。方法 选择直接经皮冠状动脉介入治疗（PCI）的STEMI 患者。通过斑点追踪心肌应变超声心动图和血压计测得血压计算无创心肌做功参数，如：心肌节段做功指数（WIs）、心肌节段有效做功（CWs）、心肌节段无效做功（WWs）和心肌节段做功效率（WEs）。LGE-CMR检查明确心肌梗死的瘢痕情况和透壁程度。心肌梗死核心区定义为LGE-CMR上透壁增强最明显的心肌节段，远离区定义为LGE-CMR上核心区直径对侧相应的无增强的心肌节段。结果 共有61例患者，1037个心肌节段纳入分析，其中124个节段在LGE-CMR上为透壁增强，425个节段为非透壁增强，488个节段为无增强。与无增强组相比，非透壁增强组、透壁增强组心肌节段WIs、CWs和WEs明显降低，WWs明显升高（均P<0.05）。WIs、CWs和WEs与LGE-CMR透壁增强呈明显负相关，WWs与透壁增强呈明显正相关（均P<0.05）。与心肌梗死远离区相比，核心区心肌节段WIs、CWs和WEs明显降低，WWs明显升高（均P<0.05）。结论 在直接接受PCI的STEMI患者中，无创心肌做功参数可能是反映心肌节段活力的潜在标志物。作为影响患者预后和潜在治疗靶点的心肌梗死远离区，可能也可用心肌做功分析来评估其心肌活力。 |
| 关键词: 超声心动图 心肌做功 心脏磁共振 心肌梗死 |
| DOI： |
| 投稿时间：2022-03-01修订日期：2022-05-10 |
| 基金项目:龙岩市科技计划联合资金项目（2021LYF17037） |
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| Correlation Study of Echocardiographic Myocardial Work Analysis and Late Contrast-enhanced Cardiac MRI in the Evaluation of Scar After Myocardial Infarction |
| HOU Shuhong,CHEN Dongping,LI Zhangjing,SUN Linlin,LIN Yong,CHEN Liling |
| (the Affiliated Longyan First Hospital of Fujian Medical University) |
| Abstract: |
| Objective To investigate the correlation between echocardiographic non-invasive assessment of myocardial work and late gadolinium contrast enhanced cardiac magnetic resonance (LGE-CMR) assessment of myocardial viability after ST-segment elevation myocardial infarction (STEMI), and the difference in myocardial work parameters between the core zone and the remote zone of myocardial infarction. Methods STEMI patients who underwent primary percutaneous coronary intervention (PCI) were included. Several non-invasive myocardial work parameters were derived from speckle tracking strain echocardiography and sphygmomanometric blood pressure, e.g.: segmental myocardial work index (WIs), segmental myocardial constructive work (CWs), segmental myocardial wasted work (WWs) and segmental myocardial work efficiency (WEs). LGE was quantified to determine infarct transmurality and scar burden. The core zone was defined as the segment with the largest extent of transmural LGE and the remote zone as the diametrically opposed segment without LGE. Results A total of 61 patients, 1037 myocardial segments were included in the analysis, of which 124 segments were transmural enhancement on LGE-CMR, 425 segments were non-transmural enhancement, 488 segments were no enhancement. Compared with the non-enhanced group, WIs, CWs, and WEs of the non-transmural enhancement group and the transmural enhancement group were significantly decreased, and WWs was significantly increased (all P<0.05). WIs, CWs and WEs were significantly negatively correlated with infarct transmurality, and WWs was significantly positively correlated with infarct transmurality (all P<0.05). Compared with the remote zone, WIs, CWs and WEs of the core zone were significantly decreased, and WWs was significantly increased (all P<0.05). Conclusions Non-invasive myocardial work parameters may serve as potential markers of segmental myocardial viability in post-STEMI patients who underwent primary PCI. Non-invasive myocardial work can also be utilized to characterize the remote zone, which is an emerging prognostic marker as well as a therapeutic target. |
| Key words: Echocardiography Myocardial work Cardiac magnetic resonance Myocardial infarction |
