摘要
目的:探讨钆延迟增强心脏磁共振(LGE-CMR)识别的隐性心肌梗死(UMI)特征及其与供血冠状动脉(冠脉)狭窄程度的相关性。方法:选择慢性稳定性心绞痛患者50例,均无心肌梗死病史,且均行心脏磁共振(CMR)检查、冠脉造影(CAG)或冠脉计算机断层扫描血管造影(CTA)检查。根据患者CMR检测发现心内膜下存在延迟强化灶者,为UMI组(n=12),其余患者被认定为无心肌梗死组(n=38)。分析UMI组患者LGE-CMR发现的心肌梗死部位、梗死面积大小及其与供血冠脉狭窄程度的相关性。结果 :50例慢性稳定性心绞痛患者中UMI发生率为24.0%(12例),UMI主要位于心肌的侧壁7个节段(30.4%)、下壁11个节段(47.8%),右冠脉供血区发生梗死较多见(12个节段,20.0%),平均梗死面积比为(5.63±3.23)%。冠脉狭窄程度与UMI的发生率呈正相关(χ~2=52.521,P<0.001,列联系数C为0.241),冠脉狭窄程度≥75%相较于冠脉狭窄程度<75%,所支配的心肌发生UMI的风险更大(OR=6.2,95%CI:2.5～15.3,P<0.0001)。结论 :UMI在慢性稳定性心绞痛患者中不少见, UMI主要位于心肌的下壁和侧壁,且梗死面积较小。重度冠脉狭窄(>75%)患者中UMI发生的概率明显增高。
Objectives: To investigate the correlation between unrecognized myocardial infarctions(UMI) detected by late gadolinium enhancement(LGE) derived from cardiovascular magnetic resonance and the severity of the stenosis of the supplying coronary artery in patients with stable angina.Methods: 50 patients with suspected coronary heart disease(mainly stable angina pectoris) and without history of myocardial infarction were enrolled. Cardiovascular magnetic resonance(CMR) was used to examine the cardiac morphology, function and detect the myocardial LGE. Coronary angiography(CAG) or coronary artery CTA was performed in all enrolled patients. The correlation between UMI and stenosis of supplying coronary artery was analyzed.Results: UMIs were evidenced in 12 patients(24.0%), and MI was mainly located in the lateral wall(31%), inferior wall(47.8%), and the infarct size was small(average infarct size: 5.63%±3.23%). The degree of coronary artery stenosis was positively correlated with the incidence of UMI(χ^2=52.521,P<0.001, the value of Contingency Coefficient=0.241), and severity of coronary stenosis was also significantly correlated with UMI segments(OR=6.2, 95% CI: 2.5-15.3). Conclusions: The incidence of UMI in patients with suspected coronary heart disease(mainly stable angina pectoris) was 24% in this patient cohort. UMIs are often small and mostly present as subendocardial infarction. Differing from the frequent locations of the recognized MI, UMIs are frequently located in inferior and lateral wall, which may be related to the distribution of sympathetic nerve in the heart. Patients with coronary stenosis≥75% are more likely to be diagnosed with UMI.
作者
曾道兵
赵新湘
常婵
ZENG Daobing;ZHAO Xinxiang;CHANG Chan(Department of PET Centre,Shiyan Tai he Hospital,Shiyan (442000),Hubei,China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第3期234-238,共5页
Chinese Circulation Journal
基金
云南省省科技厅联合专项重点项目(2017-FE468-178)
云南省中青年学术技术带头人后备人才培养项目(2015HB068)
云南省卫计委医学学科带头人培养项目(D-201646)
关键词
心脏磁共振
心肌梗死
隐性
冠状动脉狭窄
cardiac magnetic resonance
unrecognized myocardial infarctions
coronary stenosis
