Lin Guangyao, Dong Bei, Li Yuzhou, Huang Wenqi
Medical Imaging Center, The First People's Hospital of Shangqiu City No. 292, Kai Xuan Nan Road, Shangqiu 476100, Henan, China.
Am J Transl Res. 2022 Jul 15;14(7):4657-4665. eCollection 2022.
To determine the diagnostic value of cardiac magnetic resonance imaging (CMRI) for myocardial fibrosis (MF) in patients with heart failure (HF) and its predictive value for prognosis.
A total of 180 patients with heart failure who were hospitalized in the Cardiology Department of The First People's Hospital of Shangqiu City from September 2019 to May 2021 were selected and assigned to Group B (n=80) given levosimendan and Group A (n=100) given levosimendan combined with ivabradine hydrochloride. The cardiac function indicators (left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were measured by nuclear magnetic resonance (MRI). Myocardial fibrosis (MF)-related indicators (pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), N-terminal propeptide of procollagen type III (PIIINP), connective tissue growth factor (CTGF), and hyaluronic acid (HA), inflammatory factors (Hs-CRP and IL-8) were measured using ELISA. Quality of life (QoL) and physical recovery (6-min walking test (6MWT), Fugl-Meyer Assessment (FMA), and Barthel index) of the two groups were compared. The late gadolinium enhancement (LGE) was used to analyze the occurrence of MF in patients. The patients were further divided into the LGE (+) group (cases) and LGE (-) group (cases). The changes of cardiac function indicators before treatment were analyzed, and their predictive value was analyzed.
Compared with Group B, Group A showed a lower incidence of complications, and presented a higher LVEF level and lower levels of LVESV, LVESD, ICTP, PIIINP, CTGF, HA, LN, and inflammatory factors. The area under the curves of LVESV, LVESD, and LVEF in predicting MF were all >0.7.
Levosimendan combined with ivabradine hydrochloride can effectively alleviate MF in patients with MF, and CMRI has a good predictive value for MF in such patients, which is worthy of clinical promotion.
探讨心脏磁共振成像（CMRI）对心力衰竭（HF）患者心肌纤维化（MF）的诊断价值及其对预后的预测价值。
选取2019年9月至2021年5月在商丘市第一人民医院心内科住院的180例心力衰竭患者，分为B组（n = 80）给予左西孟旦，A组（n = 100）给予左西孟旦联合盐酸伊伐布雷定。采用核磁共振（MRI）测量心功能指标（左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）和左心室收缩末期内径（LVESD））。采用酶联免疫吸附测定（ELISA）法检测心肌纤维化（MF）相关指标（I型胶原吡啶交联羧基末端肽（ICTP）、III型前胶原氨基端前肽（PIIINP）、结缔组织生长因子（CTGF）和透明质酸（HA））、炎症因子（超敏C反应蛋白（Hs-CRP）和白细胞介素-8（IL-8））。比较两组患者的生活质量（QoL）和身体恢复情况（6分钟步行试验（6MWT）、Fugl-Meyer评估（FMA）和Barthel指数）。采用延迟钆增强（LGE）分析患者MF的发生情况。将患者进一步分为LGE（+）组（病例数）和LGE（-）组（病例数）。分析治疗前心功能指标的变化，并分析其预测价值。
与B组相比，A组并发症发生率较低，LVEF水平较高，LVESV、LVESD、ICTP、PIIINP、CTGF、HA、LN和炎症因子水平较低。LVESV、LVESD和LVEF预测MF的曲线下面积均>0.7。
左西孟旦联合盐酸伊伐布雷定可有效减轻MF患者的MF，CMRI对这类患者的MF具有良好的预测价值，值得临床推广。
