冠状动脉侧枝循环对STEMI患者心肌损伤影响的心血管MRI研究

目的探讨应用心血管磁共振(cardiovascular MR,CMR)多序列参数联合评价法,对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者缺血再灌注后冠状动脉侧枝循环对心肌损伤的影响进行评估,为预后诊治提供影像支撑。方法对临床确诊的37例STEMI患者以Rentrop分级标准分为侧枝循环不良组(Rentrop:0~1级)和侧枝循环良好组(Rentrop:2~3级),比较两组患者水肿心肌、梗死心肌、梗死水肿心肌比、梗死水肿心肌差以及可挽救心肌等磁共振定量参数。结果冠状动脉侧枝循环不良组患者23例,良好组14例;不良组水肿心肌略大(31.0±8.4%LV vs.28.7±7.9%LV,P=0.42);不良组梗死心肌显著高于良好组(6.7±3.2%LV vs.3.9±1.7%LV,P<0.05);梗死水肿心肌比(21.7±9.8%vs.13.8±5.8%)和可挽救心肌(78.3±9.8%vs.86.2±5.8%),不良组均显著低于良好组(P<0.05)。结论CMR可定量评估STEMI患者冠状动脉侧枝循环对PCI再灌注后心肌损伤的影响,良好的侧枝循环使得心肌可挽救部分比例升高,为预后诊治提供影像支撑。

Cardiovascular magnetic resonance study on the effect of coronary collateral circulation on myocardial injury in patients with STEMI

Objective Cardiovascular magnetic resonance imaging was used to evaluate the effect of coronary collateral circulation on myocardial injury after ischemia-reperfusion in patients with acute ST segment elevation myocardial infarction,so as to provide imaging support for prognosis and diagnosis and treatment.Methods Thirty-seven patients with STEMI were divided into two groups according to the“Rentrop classification standard”the group with poor collateral circulation(Rentrop 0~1)and the group with good collateral circulation(Rentrop 2~3).The quantitative parameters of edematous myocardium,infarcted myocardium,infarcted edema myocardial ratio,infarcted edema myocardial difference and salvable myocardium were compared between the two groups.Results There were 23 patients in the poor collateral circulation group and 14 patients in the good collateral circulation group;the edematous myocardium in the poor collateral circulation group was slightly larger(31.0±8.4%LV vs.28.7±7.9%LV,P=0.42);the infarcted myocardium in the poor collateral circulation group was significantly higher than that in the good collateral circulation group(6.7±3.2%LV vs.3.9±1.7%LV,P<0.05);the ratio of infarcted edematous myocardium(21.7±9.8%vs.13.8±5.8%)and salvable myocardium(78.3±9.8%vs.86.2±5.8%).The poor collateral circulation group was significantly lower than that good group(P<0.05).Conclusion CMR can quantitatively evaluate the effect of coronary collateral circulation on myocardial injury after PCI reperfusion in patients with STEMI.Good collateral circulation increases the proportion of myocardial salvage,which provides imaging support for prognosis and diagnosis.