多模态CMR在新型冠状病毒感染相关心肌炎中的应用价值

目的 研究多模态心脏磁共振成像（CMR）在新型冠状病毒感染相关心肌炎中的应用价值。方法 选取 2022 年 12月到 2023 年 2 月阜阳市第二人民医院 67 例新型冠状病毒感染相关心肌炎患者作为观察组，另外选出 15 例健康志愿者作为对照组。两组受检者均接受多模态 CMR 检查，并检测血液中的肌酸激酶同工酶（CK-MB）和乳酸脱氢酶（LDH）等心肌酶水平。通过计算受试者工作特征（ROC）曲线比较不同的 CMR 定量参数对新型冠状病毒感染相关心肌炎的预测效能。采用 Pearson 相关分析对多模态CMR 定量参数与 CK-MB、LDH 的相关性进行分析。结果 观察组的初始 T₁ 值、左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）、LDH 和 CK-MB 均高于对照组，而相对峰值信号强度和心肌灌注曲线下面积比值低于对照组（P<0.05）。LVESV、LVEDV、初始 T₁与 CK-MB 和 LDH 呈正相关（r=0.764、0.653、0.701、0.802，均 P＜0.05），而心肌灌注曲线下面积比和相对峰值信号强度与 CKMB 和 LDH 呈负相关（r=-0.411、-0.369）。初始 T₁值、LVEDV、LVESV、心肌灌注、相对峰值信号强度评价新冠相关心肌炎的 ROC 曲线下面积（AUC）分别为 0.921、0.692、0.711、0.701、0.716，上述指标联合检测的 AUC 为 0.943，灵敏度和特异度分别为 86.70% 和100.00%。结论 多模态 CMR 定量参数与功能参数在新型冠状病毒感染心肌炎早期评估中具有较好的临床应用价值。

Application value of multimodal CMR in COVID-19 infection associated myocarditis

Objective To study the value of multimodal cardiac magnetic resonance imaging (CMR) in the diagnosis of COVID-19 associated myocarditis. Methods From December 2022 to February 2023, 67 patients with COVID-19 infection related myocarditis in Fuyang Second People''s Hospital were selected as the observation group, and 15 healthy volunteers were selected as the control group. Both groups of subjects underwent multimodal CMR examination and were tested for creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) in blood. To compare the predictive efficacy of different CMR quantitative parameters on COVID-19 infection associated myocarditis was compared by calculating ROC curve. Pearson correlation analysis was used to analyze the correlation between quantitative parameters of multimodal CMR, CK-MB, and LDH. Results The initial T₁ value, left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), LDH, and CK-MB of the observation group were higher than those of the control group, while the relative peak signal intensity and area ratio under the myocardial perfusion curve were lower than those of the control group (P<0.05). LVESV, LVEDV, and initial T₁ were positively correlated with CK-MB and LDH (r=0.764, 0.653, 0.701, 0.802, all P<0.05), while the area ratio and relative peak signal intensity under the myocardial perfusion curve were negatively correlated with CK-MB and LDH (r = -0.411, -0.369). The AUC of initial T₁ value, LVEDV, LVESV, myocardial perfusion, and relative peak signal intensity for diagnosing COVID-19 associated myocarditis was 0.921, 0.692, 0.711, 0.701, and 0.716, respectively. The AUC of the combined detection of the above indicators was 0.943, and the sensitivity and specificity was 86.70% and 100.00%, respectively. Conclusions The quantitative and functional parameters of multimodal CMR have good clinical application value in the early assessment of COVID-19 infected myocarditis.