MRI心功能参数对陈旧性心肌梗死左心室重塑的评估价值

目的：观察陈旧性心肌梗死后心室形态和心功能参数的变化，探讨MRI测量心功能参数对心室重塑的评估价值。方法：纳入33例陈旧性心肌梗死患者为病变组，12例健康志愿者为对照组。病变组及对照组成员均行MRI检查。MRI测量参数包括：舒张末期客积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、左心室射血分数（LVEF）、射血率峰值（PER）、充盈率峰值（PFR）。同时测量梗死心肌面积所占的百分比，以24％为分界值，分为无重塑组（≤24％）和重塑组（〉24％），分析各组间的心功能参数的差异，进行受试者操作特征（ROC）曲线分析，筛选能独立评估心室重塑的心功能指标。结果：病变组的EDV、ESV、SV均高于对照组，病变组的LVEF、PER和PFR低于对照组。ESV随EDV的增加而增加（P〈0．001），PER、PFR及LVEF均随EDV的增加而下降（P〈0．05），而SV与各参数均无相关性。PFR、EDV和ESV的ROC分析曲线下面积分别为0．725、0．741、0．764，分界值分别为2．27EDV／sec、140．23ml和79．12ml（P值分别为0．036、0．021和0．032）。结论：MRI可以从收缩和舒张功能的不同角度全面地评估心功能变化。MRI心功能指标对评估心室重塑有重要作用。PFR、EDV、ESV可以作为独立因子评估心室重塑，其中以PFR的评估效能更高。

Value of MRI cardiac function parameter for assessment of left ventricular remodeling in old myocardial infarction

Objective：To observe the change of cardiac function of old myocardial infarction （OMI） and to investigate the value of MRI cardiac function parameter for assessment of left ventricular remodeling in myocardial infarction. Methods： Thirty-three patients with OMI, including 27 males and 6 females were enrolled. Twelve healthy volunteers were control group. All patients and healthy controls underwent MRI examination. MRI measurement of heart function parameters in cluded：left ventricular end diastolic volume （EDV）,end systolic volume （ESV）, stroke volume （SV）,left ventricular ejec-tion fraction （LVEF） ,peak of ejection rate （PER） ,peak of filling rate （PFR） ,and measure the percentage of the area ratio of myocardial infarction. As a cutoff line of 24 %, patients were divided into two groups with no remodeling group and re-modeling group. The parameters of heart function were analyzed. The receiver operating characteristic （ROC） analysis was used to assess the value of MRI cardiac function parameter for assessment of left ventricular remodeling in myocardial in-farction. Results：The ventricular function parameters EDV,ESV and SV of OMI were higher than those of control groups, however,the values of LVEF,PER and PFR were lower. The increase of ESV has a linear relationship with EDV. With the increase of EDV, the value of PER,PFR and LVEF tended to decline. While there was no relationship between SV and other parameters. PFR,EDV,ESV could be used as independent factors for assessment of ventricular remodeling, with the areas under the curve （AUC） were 0. 725,0. 741 and 0. 764 by using receiver operating curves （ROC） analysis,and the cut-off values were 2.27 ml/s, 140.23ml and 79.12ml, and the P value was 0. 036,0. 021 and 0.032 respectively. Conclusion： Systol-ic and diastolic function can be used to evaluate cardiac function by using MRI,and these parameters played important roles on assessment of ventricular remodeling. PFR,EDV and ESV can be used as an independent factor to assesses ventricular remodeling. In particular, the PFR shows higher performance than other parameters.