李俊超,李梦露,王晶,周肖,程流泉,董蔚,陈韵岱

• 1:解放军总医院心内科
• 2:解放军总医院放射科

摘要(Abstract)：

目的应用基于心脏磁共振成像(MRI)电影序列的特征追踪技术分析急性心肌梗死患者左心室心肌应变,探索其与急性心肌梗死透壁程度的关系,及急诊经皮冠状动脉介入治疗(PCI)术后心肌应变演变规律。方法入组74例急性ST段抬高型心肌梗死(STEMI)患者,均于急性心肌梗死12 h内接受急诊PCI,术后2~5 d,行心电门控稳态自由进动序列扫描采集电影序列图像,同时行钆对比剂延迟强化,得到短轴强化序列图像。其中20例3~5月后复查MRI。应用Tom Tec 2D CPA软件分析电影序列,得到局部心肌应变指标,(包括各节段内膜圆周、径向、纵向应变峰值),和整体心肌应变指标(包括整体圆周、径向、纵向应变值),应用Segment分析软件计算延迟强化序列各个节段心肌梗死透壁程度。结果本研究74例STEMI患者,梗死面积为(11.81±7.28)%。分析得到537个无梗死节段,425个非透壁梗死节段,182个透壁梗死节段。圆周应变峰值基底段无梗死节段(–23.90±10.92)%、非透壁梗死节段(–18.94±10.51)%、透壁梗死节段(–14.24±9.05)%,两两比较发现,无梗死节段指标(取绝对值)显著高于非透壁梗死节段(P=0.000),非透壁梗死节段指标显著高于透壁梗死节段(P=0.016)。圆周应变峰值中间段无梗死节段(–22.13±9.98)%、非透壁梗死节段(–17.47±8.72)%、透壁梗死节段(–12.71±8.92)%,两两比较发现,无梗死节段指标(取绝对值)显著高于非透壁梗死节段(P=0.000),非透壁梗死节段指标显著高于透壁梗死节段(P=0.000)。圆周应变峰值心尖段无梗死节段(–22.46±10.31)%、非透壁梗死节段(–19.51±12.49)%、透壁梗死节段(–13.81±11.13)%,两两比较发现,透壁梗死节段指标(取绝对值)显著低于无梗死节段(P=0.000)与非透壁梗死节段(P=0.001),但无梗死节段与非透壁梗死节段指标比较,差异无统计学意义。纵向应变峰值在基底段与中间段,无梗死节段、非透壁梗死节段及透壁梗死节段指标比较,差异无统计学意义;但心尖段三个阶段指标分别是(–20.26±12.42)%,(–14.82±11.29)%,(–11.94±9.73)%,两两比较发现,无梗死节段指标(取绝对值)显著高于非透壁梗死节段(P=0.000),非透壁梗死节段显著高于透壁梗死节段(P=0.043)。径向应变峰值在基底段无梗死节段(31.92±17.47)%与非透壁梗死节段(22.35±18.57)%比较,差异有统计学意义(P=0.000),与透壁梗死节段(17.78±16.24)%比较,差异有统计学意义(P=0.000),但非透壁梗死节段与透壁梗死节段比较,差异无统计学意义。径向应变峰值在中间段无梗死节段(32.13±16.37)%、非透壁梗死节段(25.20±15.85)%、透壁梗死节段(15.20±10.48)%,两两比较发现,无梗死节段指标显著高于非透壁梗死节段(P=0.000),非透壁梗死节段指标显著高于透壁梗死节段(P=0.000)。径向应变峰值心尖段无梗死节段(27.42±14.94)%与非透壁梗死节段(20.51±15.43)%比较,差异有统计学意义(P=0.001),与透壁梗死节段(16.59±11.84)%比较,差异有统计学意义(P=0.000),但非透壁梗死节段与透壁梗死节段比较,差异无统计学意义。20例患者PCI术后无梗死节段、非透壁梗死节段、透壁梗死节段圆周应变、纵向应变及径向应变达峰值均较急性心肌梗死时有升高趋势。其中非透壁梗死节段圆周应变(取绝对值)及纵向应变(取绝对值)较PCI术前升高[(–16.88±9.92)%比(–19.46±11.31)%,P=0.018;(–12.02±9.46)%比(–16.67±11.29)%,P=0.000];透壁梗死节段圆周应变(取绝对值)及径向应变较PCI术前升高[(–13.83±9.47)%比(17.20±10.63)%,P=0.035;(18.36±12.85)%比(24.55±14.81)%,P=0.001],差异均有统计学意义。结论急诊PCI术后STEMI患者,在急性期局部心肌应变在无梗死节段、非透壁梗死节段、透壁梗死节段之间有差别。PCI术后3~5个月,非透壁梗死节段圆周应变及纵向应变较急性期时改善,而透壁梗死节段圆周应变及径向应变改善。心脏磁共振成像特征追踪技术与钆对比剂延迟技术相结合,可从功能学和组织学特征两方面对急性心肌梗死心肌损伤综合评估。

关键词(KeyWords)： 特征追踪技术;心脏磁共振成像;急性心肌梗死;心肌应变

Abstract:

Keywords:

基金项目(Foundation): 临床特色优势技术项目(2015FC-TSYS-2004);; “十二五”国家科技支撑计划课题(2011BAI11B10)

作者(Author): 李俊超,李梦露,王晶,周肖,程流泉,董蔚,陈韵岱

参考文献(References)：

• [1]Karamitsos TD,Francis JM,Myerson S,et al.The role of cardiovascular magnetic resonance imaging in heart failure.J Am Coll Cardiol,2009,54(15):1407-1424.
• [2]Zerhouni EA,Parish DM,Rogers WJ,et al.Human heart:tagging with MR imaging--a method for noninvasive assessment of myocardial motion.Radiology,1988,169(1):59-63.
• [3]Hundley WG,Bluemke DA,Finn JP,et al.ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance:a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents.Circulation,2010,121(22):2462-2508.
• [4]Vartdal T,Brunvand H,Pettersen E,et al.Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion.J Am Coll Cardiol,2007,49(16):1715-1721.
• [5]Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart.A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.Circulation,2002,105(4):539-542.
• [6]Osman NF,Kerwin WS,Mc Veigh ER,et al.Cardiac motion tracking using CINE harmonic phase(HARP)magnetic resonance imaging.Magn Reson Med,1999,42(6):1048-1060.
• [7]Aletras AH,Ding S,Balaban RS,et al.DENSE:displacement encoding with stimulated echoes in cardiac functional MRI.J Magn Reson,1999,137(1):247-252.
• [8]Osman NF,Sampath S,Atalar E,et al.Imaging longitudinal cardiac strain on short-axis images using strain-encoded MRI.Magn Reson Med,2001,46(2):324-334.
• [9]Schuster A,Kutty S,Padiyath A,et al.Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress.J Cardiovasc Magn Reson,2011,13:58.
• [10]Salerno M.Feature Tracking by CMR:A"Double Feature"?JACC Cardiovasc Imaging,2017 May 11.[Epub ahead of print]
• [11]Goto Y,Ishida M,Takase S,et al.Comparison of Displacement Encoding With Stimulated Echoes to Magnetic Resonance Feature Tracking for the Assessment of Myocardial Strain in Patients With Acute Myocardial Infarction.Am J Cardiol,2017,119(10):1542-1547.
• [12]Khan JN,Singh A,Nazir SA,et al.Comparison of cardiovascular magnetic resonance feature tracking and tagging for the assessment of left ventricular systolic strain in acute myocardial infarction.Eur J Radiol,2015,84(5):840-848.
• [13]Schuster A,Morton G,Hussain ST,et al.The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength.Eur J Radiol,2013,82(2):296-301.
• [14]Ohyama Y,Ambale-Venkatesh B,Chamera E,et al.Comparison of strain measurement from multimodality tissue tracking with strainencoding MRI and harmonic phase MRI in pulmonary hypertension.Int J Cardiol,2015,182:342-348.
• [15]Sj?li B,?rn S,Grenne B,et al.Diagnostic capability and reproducibility of strain by Doppler and by speckle tracking in patients with acute myocardial infarction.JACC Cardiovasc Imaging,2009,2(1):24-33.
• [16]Chan J,Hanekom L,Wong C,et al.Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function.J Am Coll Cardiol,2006,48(10):2026-2033.
• [17]Riffel JH,Keller MG,Rost F,et al.Left ventricular long axis strain:a new prognosticator in non-ischemic dilated cardiomyopathy?J Cardiovasc Magn Reson,2016,18(1):36.
• [18]Brunvand H,Rynning SE,Hexeberg E,et al.Non-uniform recovery of segment shortening during reperfusion following regional myocardial ischaemia despite uniform recovery of ATP.Cardiovasc Res,1995,30(1):138-146.
• [19]Butz T,Lang CN,van Bracht M,et al.Segment-orientated analysis of two-dimensional strain and strain rate as assessed by velocity vector imaging in patients with acute myocardial infarction.Int J Med Sci,2011,8(2):106-113.
• [20]Liu H,Yang D,Wan K,et al.Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers.Sci Rep,2017,7:45314.