Cho Dong-Hyuk, Son Jung-Woo, Kim Young In, Lim Jihye, Jeon Ho-Sung, Ko Sung Min, Cha Yong Sung
Department of Cardiology, Korea University College of Medicine, Seoul 26426, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26493, Republic of Korea.
Diagnostics (Basel). 2023 Dec 27;14(1):60. doi: 10.3390/diagnostics14010060.
Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMRI) reflects the burden of myocardial damage in carbon monoxide (CO) poisoning. This study aimed to identify the clinical and echocardiographic parameters that can predict myocardial LGE on CMRI in CO poisoning. This prospective observational study included patients who presented with acute CO poisoning and elevated troponin I and underwent echocardiography and CMRI to identify myocardial damage at a tertiary university hospital between August 2017 and May 2019 and August 2020 and July 2022. Based on the CMRI findings, participants were categorized into LGE and non-LGE groups. The median age of the 155 patients was 51.0 years, and 98 (63.2%) were males. Median times from emergency department arrival to either CMRI or echocardiography were 3.0 days each. The LGE group included 99 (63.9%) patients with LGE positivity on CMRIs. Time from rescue to hyperbaric oxygen therapy >4 h (odds ratio (OR): 3.31, 95% confidence interval (CI): 1.28-8.56, 0.01); serum lactate levels >2 mmol/L (OR: 2.62, 95% CI: 1.20-5.73, 0.02); and left ventricular global longitudinal strain >-16% (OR: 2.95, 95% CI: 1.35-6.47, 0.007) were significant predictors of LGE positivity. The area under the curve of these predictors was 0.711. Our prediction model, which combines the clinical parameters with left ventricular global longitudinal strain, may be helpful in the early detection of LGE positivity.
心脏磁共振成像（CMRI）中的延迟钆增强（LGE）反映了一氧化碳（CO）中毒时心肌损伤的程度。本研究旨在确定可预测CO中毒患者CMRI上心肌LGE的临床和超声心动图参数。这项前瞻性观察性研究纳入了2017年8月至2019年5月以及2020年8月至2022年7月期间在一家三级大学医院就诊的急性CO中毒且肌钙蛋白I升高的患者，这些患者接受了超声心动图和CMRI检查以确定心肌损伤情况。根据CMRI检查结果，参与者被分为LGE组和非LGE组。155例患者的中位年龄为51.0岁，其中98例（63.2%）为男性。从急诊科就诊到CMRI或超声心动图检查的中位时间均为3.0天。LGE组包括99例（63.9%）CMRI显示LGE阳性的患者。从抢救到高压氧治疗的时间>4小时（比值比（OR）：3.31，95%置信区间（CI）：1.28 - 8.56，P = 0.01）；血清乳酸水平>2 mmol/L（OR：2.62，95% CI：1.至5.73，P = 0.02）；以及左心室整体纵向应变>-16%（OR：2.95，95% CI：1.35 - 6.47，P = b）是LGE阳性的显著预测因素。这些预测因素的曲线下面积为0.711。我们将临床参数与左心室整体纵向应变相结合的预测模型可能有助于早期检测LGE阳性。
