磁共振成像对冠心病陈旧性心肌梗死所致心功能不全的诊断及干细胞移植疗效评价的应用

目的 评价磁共振成像(MRI)在冠心病陈旧性心肌梗死合并心功能不全患者诊断中的价值,并分析干细胞移植手术的疗效.方法 20例冠心病陈旧性心肌梗死患者,男18例,女2例,年龄(59.5±10.1)岁,半均分成2组(每组10例),干细胞移植组行冠状动脉旁路移植术(CABG)+干细胞移植,对照组仅行CABG术,术前均行心脏MRI及双核素单光子发射计算机断层(SPECT)进行存活心肌显像检查,术后6个月复查心脏MRI.用MRI评价干细胞移植后左心功能改善及心脏MRI延迟增强显像判断左室存活心肌的准确性.结果 两组左室射血分数(LVEF)均有明显改善,但手术前后变化值比较差异无统计学意义.干细胞移植组左室舒张末期容积(LVEDV)手术前后变化值为(9.91±39.50)ml,与对照组的(-22.34±31.35)ml比较,差异有统计学意义(P＜0.05);干细胞移植组窒壁增厚率变化值高于对照组(11.40%±11.53%比2.27%±7.20%,P＜0.05),其余两组心功能参数变化值比较差异均无统计学意义.心脏MRI延迟增强显像与氟-18-脱氧葡萄糖(18F-FDG)心肌代谢存活心肌显像具有较好的一致性,Kappa=0.446(P＜0.001).以18F-FDG SPECT心肌代谢显像为金标准,心脏MRI延迟增强显像敏感度为68.3%,特异度为92.5%.结论 MRI能够准确判断冠心病陈旧性心肌梗死患者左室容积和功能,对心肌梗死后存活心肌的判断具有同18F-FDG SPECT相近的特异性,但敏感件略低.MRI可用于心肌十细胞移植前诊断与移植后早期疗效的判定.

Assessment of therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction by magnetic resonance imaging

Objective To evaluate the therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction (OMI) by MRI.nethods Hcart failure patients NYHA 2.7±0.7,male=18,mean age (59.5±10.1) Y] with OMI were randomly divided into 2 groups (group A:CABG+stem cell transplantation,group B:CABG;n=10 each).Left ventricular (LV) function was measured by MRI,viable myoeardium was detected by 18F-FDG myocardial metabolism imaging and late contrast-enhanced at baseline and 6 months post intervention.Results LVEF and LVEDV at baseline for group A were (20.71±6.09)% and (172.73±32.74) ml,and for group B were (27.59±2.31)% and (155.13±28.36)ml,respectively (P＞0.05).The LVEF was equally improved in group A and B (mean 8.63% vs.10.37%,P＞0.05) while ALVEDV was significant higher in group A than that in group B (9.91±39.50)ml vs.(-22.34±31.35)ml.P＜0.05].Ventricular wall thickening ratio at 6 months post intervention was significantly higher in group A than that in group B(11.40 ±11.53)% vs.(2.27±7.20)%,P＜0.05].Late contrast-enhanced M RI results correlated with 18F-FDG myocardial metabolism imaging SPECT well in assessment of myocardial viability (kappa value:0.446,P＜0.001;sensitivity:68.3% and specificity:92.5%).Conclusions Stem cell therapy on top of CABG aggravated LV remodeling in heart failure patients with old myocardial infarction.The specificity of MRI Is similar to 18F-FDG SPECT while the sensitivity is inferior to 18F-FDG SPECT on detecting viable myocardium.