摘要
目的:探讨瘢痕心肌对心功能不全的心肌梗死患者冠状动脉旁路移植术(CABG)后心血管事件的预测价值。方法:连续纳入本院成人外科中心2010年4月至2013年4月期间心功能不全的心肌梗死患者134例,术前行延迟钆强化心脏MRI(LGE-CMR)检查,用国际通用的17节段分析法评估患者的瘢痕心肌以及心室功能。对所有患者进行门诊或电话随访,了解患者的症状改善、心功能恢复以及心血管事件发生情况,最终128例患者纳入分析。CABG后发生心血管事件的患者有27例(心血管事件组),未发生心血管事件的患者101例(无心血管事件组)。对影响心血管事件的相关因素进行分析。结果:Cox比例风险回归模型单因素分析显示,左心室射血分数、左心室舒张末期容积指数、左心室收缩末期容积指数、运动不良节段数、室壁运动评分、受累心肌节段数、瘢痕心肌节段数、延迟钆强化(LGE)总评分、NYHA心功能分级均是影响患者CABG后发生心血管事件的危险因素(P均<0.001)。Cox比例风险回归模型多因素分析显示,瘢痕心肌节段数是心血管事件的独立危险因素(HR=2.372,95%CI:1.312~4.288,P=0.004)。ROC曲线分析显示,瘢痕心肌节段≥6个时,患者更易发生心血管事件,瘢痕心肌节段≥6个预测心血管事件的敏感度和特异度分别为74.1%和95.0%(AUC=0.926,P<0.001)。平均随访(103.5±11.8)个月,Kaplan-Meier生存曲线分析显示,所有患者CABG后累积无心血管事件生存率为78.9%。瘢痕心肌节段数<6个的患者的累积无心血管事件生存率明显高于瘢痕心肌节段数≥6个的患者(95.1%vs.12.0%,P<0.001)。结论:对于心功能不全的心肌梗死患者,基于LGE-CMR的瘢痕心肌节段数是CABG后心血管事件的独立危险因素。
Objectives:To evaluate the value of myocardial scar burden for predicting cardiovascular events in patients with myocardial infarction and cardiac dysfunction after coronary artery bypass graft(CABG).Methods:Consecutive patients with myocardial infarction and cardiac dysfunction evidenced by late gadolinium enhancement cardiovascular magnetic resonance imaging(LGE-CMR)before CABG from April 2010 to April 2013 were enrolled.Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before CABG.A standard 17-segment model was used for scar quantification.Patients were followed up by outpatient clinic or telephone call and predictors for cardiovascular events were analyzed.Results:A total of 128 patients were enrolled in this study,the average follow-up time was(103.5±11.8)months.Cardiovascular events were recorded in 27 patients after CABG.Univariate analysis demonstrated that left ventricular ejection fraction,left ventricular end-diastolic volume index,left ventricular end-systolic volume index,dysfunctional segments,wall motion score,spatial extent,the number of scar segments,LGE score and NYHA classification were the risk factors of cardiovascular events after CABG(all P<0.001).Cox proportional hazard regression model analysis showed that the number of scar segments on LGE-CMR was the only independent predictor for cardiovascular events(HR=2.372,95%CI:1.312-4.288,P=0.004).The ROC curve analysis showed that the number of scar segments≥6 could effectively predict cardiovascular events with a sensitivity and specificity of 74.1%and 95.0%,respectively.Kaplan-Meier survival curve analysis showed that the cumulative cardiovascular event free survival rate of all patients was 78.9%.The cumulative cardiovascular event free survival rate of patients with scar segments<6 was significantly higher than that of patients with scar segments≥6(95.1%vs.12.0%,P<0.001).Conclusions:Myocardial scar burden based on LGE-CMR is an independent predictor of cardiovascular events after CABG in patients with myocardial infarction and cardiac dysfunction.
作者
杨滔
袁昕
陆敏杰
李宝童
张兴
杨研
赵世华
孙寒松
YANG Tao;YUAN Xin;LU Minjie;LI Baotong;ZHANG Xing;YANG Yan;ZHAO Shihua;SUN Hansong(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第10期978-984,共7页
Chinese Circulation Journal
基金
北京市自然科学基金(7204289)
中央高校基本科研业务费(3332020020)。
关键词
冠心病
心功能不全
延迟钆强化心血管磁共振成像
冠状动脉旁路移植术
coronary artery disease
cardiac dysfunction
late gadolinium enhancement cardiovascular magnetic resonance imaging
coronary artery bypass graft
