摘要
目的:通过心脏磁共振成像技术探讨ST段抬高型心肌梗死(STEMI)后持续性T波倒置(PTI)与心肌损伤的关系。方法:纳入142例STEMI行血运重建的患者,梗死后普通12导心电图检查提示PTI和病理性Q波存在至少4个月。心脏磁共振成像检测(CMR)在梗死后1周内和4个月的时候进行,评估梗死特点和心肌功能。结果:有PTI的患者(n=103, 73%)显示出较大的急性[21(11,29)%vs. 6(1,13)%,P<0.001]和慢性[14(8,19)%vs. 3(1,8)%,P<0.001]梗死面积,并且微血管阻塞较常见。校准病理性Q波、心肌梗死面积大小估计值(hs-CTnT, hs-CRP,Nt-proBNP,罪犯血管,介入前TIMI血流)后,PTI与慢性梗死面积之间的关联仍然显著(OR=9.02, 95%CI:3.49～23.35,P<0.001)。T波倒置幅度对面积>11%慢性梗死的预测价值(AUC:0.84, 95%CI:0.77～0.90)明显高于Q波幅度(AUC=0.72, 95%CI:0.63～0.80,P=0.009); PTI与病理性Q波或Q波/T波评分的组合预测梗死面积优于PTI单独预测(95%CI:0.29～0.57,P<0.001)。结论:STEMI后的PTI与CMR显示的更广泛的心肌损伤相关。PTI与病理性Q波或Q波/T波评分相结合的心电图评分系统可能对STEMI后的高度准确的梗塞面积估计有一定价值。
Objective: To investigate the relationship between persistent T wave inversion(PTI) and myocardial injury after ST-segment elevation myocardial infarction(STEMI) by cardiac magnetic resonance imaging. Methods: A total of 142 patients with STEMI underwent revascularization. The usual 12-lead ECG after infarction indicated PTI and pathological Q wave for at least 4 months. Cardiac magnetic resonance imaging(CMR) was performed at 1 week and 4 months after infarction to assess infarct characteristics and myocardial function. Results: Patients with PTI(n=103, 73%) showed greater acute [21(11,29) % vs. 6(1,13)%,P<0.001]and chronic [14(8,19) % vs. 3(1,8)%,P<0.001]infarct size, and microvascular obstruction is more common. After calibrating pathological Q-wave, myocardial infarct size estimates(hs-CTnT, hs-CRP, Nt-proBNP, criminal blood vessels, pre-interventional TIMI blood flow), the association between PTI and chronic infarct size remained significant(OR=9.02, 95% CI=3.49-23.35, P<0.001). The predicted value of T wave inversion for chronic infarcts greater than 11%(AUC=0.84, 95% CI:0.77-0.90) was significantly higher than Q wave amplitude(AUC=0.72, 95% CI:0.63-0.80, P=0.009);PTI and The combination of pathological Q-wave or Q-wave/T-wave scores predicted infarct size over PTI alone(95% CI:0.29-0.57;P<0.001). Conclusions: PTI after STEMI are independently associated with broader myocardial damage demonstrated by CMR. An electrocardiographic scoring system combining PTI with pathological Q-wave or Q-wave/T-wave scores may have some value for estimating highly accurate infarct size after STEMI.
作者
吴多益
许和平
孙娟
李全妮
WU Duoyi;XU Heping;SUN Juan;LI Quanni(Department of Emergency,Hainan General Hospital,Haikou 570311,China)
出处
《心肺血管病杂志》
2018年第12期1059-1065,共7页
Journal of Cardiovascular and Pulmonary Diseases
关键词
ST段抬高心肌梗死
持续性T波倒置
梗死面积
磁共振成像
ST-elevation myocardial infarction
Persistent T-wave inversion
Infarct size
Magnetic resonance imaging
