慢性冠状动脉综合征的血运重建后区域性重构：心脏磁共振特征追踪研究。

Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study.

机构信息

Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.

出版信息

J Magn Reson Imaging. 2024 Jun;59(6):2265-2274. doi: 10.1002/jmri.29026. Epub 2023 Sep 29.

DOI:10.1002/jmri.29026

PMID:37772452

Abstract

BACKGROUND

MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear.

PURPOSE

To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT.

STUDY TYPE

Prospective.

SUBJECTS

50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years).

FIELD STRENGTH/SEQUENCE: 1.5T with balanced steady-state free precession cine sequence.

ASSESSMENT

Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory.

STATISTICAL TESTS

Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level.

RESULTS

Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208).

DATA CONCLUSION

Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 4.

摘要

背景

MRI 特征追踪（MRI-FT）可准确评估心室心肌变形和局部功能，并且可能比射血分数和梗死扩展更好地预测死亡率。然而，MRI-FT 在评估冠状动脉血运重建中的作用尚不清楚。

目的

通过 MRI-FT 评估慢性冠状动脉综合征（CCS）患者冠状动脉血运重建对区域性左心室（LV）功能的影响。

研究类型

前瞻性。

受试者

50 名计划接受选择性经皮冠状动脉介入治疗（PCI）的 CCS 患者（年龄：62.22±8.70 岁）和 30 名健康对照者（年龄：35.33±11.57 岁）。

场强/序列：1.5T 采用平衡稳态自由进动电影序列。

评估

由有经验的操作人员使用专用软件对患者和健康对照组的整体和节段性收缩期纵向、周向和径向心肌应变进行定量分析。患者在 PCI 前和 PCI 后 6 个月进行研究，通过计算每个血运重建区域的节段值来计算 LV 区域性心肌应变值。

统计学检验

学生 t 检验、配对 t 检验、Mann Whitney 检验和 Wilcoxon 符号秩检验。在 5%的水平上判断显著性。

结果

在前降支（LAD）和右冠状动脉（RCA）区域，区域性纵向应变在 PCI 后 6 个月有显著改善，但在回旋支（LCX）区域没有（LAD：平均-11.41%±3.45%，前；-13.01%±3.53%，后；RCA：平均-11.11%±2.65%，前；-13.25%±2.81%，后；LCX：平均-15.43%±3.97%，前；-16.17%±4.38%，后，P=0.215）。所有血运重建区域的区域性周向应变在 PCI 后均有显著改善（LAD：平均-13.73%±6.56%，前；-16.98%±6.01%，后；LCX：平均-13.23%±4.23%，前；-16.34%±3.45%，后；RCA：平均-11.24%±3.36%，前；-13.80%±3.51%，后）。区域性径向应变在 PCI 后没有显著改善（LAD：平均 22.73%±12.38%，前；21.79%±11.55%，后，P=0.541；LCX：平均 27.73%±7.95%，前；29.0%±7.25%，后，P=0.264；RCA：平均 36.68%±11.10%，前；31.75%±10.95%，后，P=0.208）。