对比增强心脏磁共振成像评估 2 型糖尿病心肌梗死后心肌瘢痕对左心室变形的影响。
Impact of myocardial scars on left ventricular deformation in type 2 diabetes mellitus after myocardial infarction by contrast-enhanced cardiac magnetic resonance.
机构信息
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
出版信息
Cardiovasc Diabetol. 2021 Oct 25;20(1):215. doi: 10.1186/s12933-021-01407-2.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarction (MI). The interaction of diabetic cardiomyopathy and MI scars on myocardial deformation in T2DM patients is unclear. Therefore, we aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation.
METHODS
Overall, 202 T2DM patients, including 46 with MI (T2DM(MI+)) and 156 without MI (T2DM(MI-)), and 59 normal controls who underwent CMR scans were included. Myocardial scars were assessed by late gadolinium enhancement. LV function and deformation, including LV global function index, LV global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR), were compared among these groups. Correlation and multivariate linear regression analyses were used to investigate the relationship between myocardial scars and LV deformation.
RESULTS
Decreases were observed in LV function and LV global PS, PSSR, and PDSR in the T2DM(MI+) group compared with those of the other groups. Reduced LV deformation (p < 0.017) was observed in the T2DM(MI+) group with anterior wall infarction. The increased total LV infarct extent and infarct mass of LV were related to decreased LV global PS (radial, circumferential, and longitudinal directions; p < 0.01) and LV global PSSR (radial and circumferential directions, p < 0.02). Multivariate analysis demonstrated that NYHA functional class and total LV infarct extent were independently associated with LV global radial PS (β = - 0.400 and β = - 0.446, respectively, all p < 0.01; model R = 0.37) and circumferential PS (β = 0.339 and β = 0.530, respectively, all p < 0.01; model R = 0.41), LV anterior wall infarction was independently associated with LV global longitudinal PS (β = 0.398, p = 0.006).
CONCLUSIONS
The myocardial scarring size in T2DM patients after MI is negatively correlated with LV global PS and PSSR, particularly in the circumferential direction. Additionally, different MI regions have different effects on the reduction of LV deformation, and relevant clinical evaluations should be strengthened.
背景
2 型糖尿病（T2DM）是冠状动脉疾病和心肌梗死（MI）的主要危险因素。糖尿病心肌病与 T2DM 患者 MI 疤痕之间的相互作用对心肌变形的影响尚不清楚。因此，我们旨在使用心脏磁共振（CMR）评估既往 MI 的 T2DM 患者的心肌变形，并研究 MI 疤痕对左心室（LV）变形的影响。
方法
共纳入 202 名 T2DM 患者，其中 46 名患有 MI（T2DM（MI+）），156 名无 MI（T2DM（MI-）），59 名正常对照者接受 CMR 扫描。通过晚期钆增强评估心肌疤痕。比较这些组之间的 LV 功能和变形，包括 LV 整体功能指数、LV 整体峰值应变（PS）、收缩期峰值应变率（PSSR）和舒张期峰值应变率（PDSR）。使用相关和多元线性回归分析来研究心肌疤痕与 LV 变形之间的关系。
结果
与其他组相比，T2DM（MI+）组的 LV 功能和 LV 整体 PS、PSSR 和 PDSR 降低。在前壁梗死的 T2DM（MI+）组中观察到 LV 变形降低（p<0.017）。增加的总 LV 梗死范围和 LV 梗死质量与 LV 整体 PS（径向、圆周和纵向方向；p<0.01）和 LV 整体 PSSR（径向和圆周方向，p<0.02）降低相关。多元分析表明，纽约心脏协会功能分级和总 LV 梗死范围与 LV 整体径向 PS（β=-0.400 和 β=-0.446，均 p<0.01；模型 R=0.37）和圆周 PS（β=0.339 和 β=0.530，均 p<0.01；模型 R=0.41）呈负相关，LV 前壁梗死与 LV 整体纵向 PS（β=0.398，p=0.006）独立相关。
结论
MI 后 T2DM 患者的心肌疤痕大小与 LV 整体 PS 和 PSSR 呈负相关，特别是在圆周方向。此外，不同的 MI 区域对 LV 变形的降低有不同的影响，应加强相关临床评估。
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