采用 3.0T 心脏磁共振成像评估代谢综合征患者冠状动脉狭窄加重对左心室功能和变形的影响。

Assessing coronary artery stenosis exacerbated impact on left ventricular function and deformation in metabolic syndrome patients by 3.0 T cardiac magnetic resonance imaging.

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 Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.

出版信息

Cardiovasc Diabetol. 2024 Nov 18;23(1):414. doi: 10.1186/s12933-024-02492-9.

DOI:10.1186/s12933-024-02492-9

PMID:39558352

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11575079/

Abstract

BACKGROUND

Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients.

METHODS

One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS-) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain.

RESULTS

Compared to MetS(CAS-), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS-) through MetS(NOCAS+) to MetS(OCAS+) (- 13.02 ± 2.32% vs. - 10.34 ± 4.05% vs. - 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = - 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685).

CONCLUSION

Besides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population.

摘要

背景

代谢综合征（MetS）和冠状动脉狭窄（CAS）独立增加心血管事件的风险，而 CAS 对 MetS 患者左心室（LV）功能和变形的影响尚不清楚。本研究旨在探讨不同程度的 CAS 如何加重 MetS 患者的 LV 功能和心肌变形。

方法

对 131 例接受 CMR 检查的 MetS 患者进行分组：MetS（CAS-）组（n=47）和 MetS（CAS+）组（n=84）。MetS（CAS+）组再分为非阻塞性 CAS（NOCAS+）（n=30）和阻塞性 CAS（OCAS+）（n=54）。此外，还纳入 48 名年龄和性别匹配的受试者作为对照组。测量并比较各组 LV 功能和变形参数。采用线性回归分析所有 MetS 患者 LV 整体峰值应变降低的决定因素。受试者工作特征（ROC）曲线和逻辑回归模型（LRM）评估 CAS 程度对识别 LV 应变受损的诊断准确性。

结果

与 MetS（CAS-）相比，MetS（NOCAS+）的 LV 质量指数明显增加（p<0.05）。从 MetS（CAS-）到 MetS（NOCAS+）再到 MetS（OCAS+），LV 整体纵向峰值应变逐渐降低（-13.02±2.32% vs. -10.34±4.05% vs. -7.55±4.48%，p<0.05）。与 MetS（NOCAS+）相比，MetS（OCAS+）组在径向和圆周方向的 LV 整体峰值应变（GPS）、PSSR 和 PDSR 明显降低（均 p<0.05）。CAS 程度与 MetS 患者的整体径向峰值应变（GRPS）（β=-0.289，p<0.001）和整体纵向峰值应变（GLPS）（β=0.254，p=0.004）独立相关。ROC 分析表明，CAS 程度可以预测 GRPS 受损（AUC=0.730）和 GLPS 受损（AUC=0.685）。