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浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (5): 511-516    DOI: 10.3785/j.issn.1008-9292.2019.10.08
原著     
心肌瘢痕对慢性心肌梗死后恶性室性心律失常发生的预测价值
郭丹玲1(),胡红杰2,*(),赵振华1,*(),吕桑英1,黄亚男1,蒋汝红3,蒲彩玲2,倪虹霞1
1. 浙江省绍兴市人民医院放射科, 浙江 绍兴 312000
2. 浙江大学医学院附属邵逸夫医院放射科, 浙江 杭州 310016
3. 浙江大学医学院附属邵逸夫医院心内科, 浙江 杭州 310016
Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction
GUO Danling1(),HU Hongjie2,*(),ZHAO Zhenhua1,*(),LYU Sangying1,HUANG Yanan1,JIANG Ruhong3,PU Cailing2,NI Hongxia1
1. Department of Radiology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
2. Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
3. Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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摘要：

目的: 分析心脏磁共振延迟强化量化的心肌瘢痕质量对慢性心肌梗死后恶性心律失常（MVA）发生的预测价值。方法: 选取2012年1月至2017年8月浙江大学医学院附属邵逸夫医院有完整腔内电生理及心脏磁共振资料的心肌梗死患者30例，根据腔内电生理检查结果分为两组：诱发出MVA组（16例）及未诱发出MVA组（14例）。通过CVI42后处理软件对左心室射血分数（LVEF）及延迟强化评估的心肌瘢痕进行定性及定量分析，ROC曲线分析比较心肌瘢痕与LVEF对心肌梗死后MVA的预测价值。结果: 诱发出MVA组LVEF明显低于未诱发出MVA组，延迟强化评估的瘢痕质量也更大（均P < 0.05）。回归分析发现，心肌瘢痕质量及LVEF为心肌梗死后MVA发生的风险因子（OR=6.270和1.580）。ROC曲线分析结果显示，LVEF预测心肌梗死后MVA的AUC为0.696，敏感度为0.786，特异度为0.685；瘢痕质量预测心肌梗死后恶性室性心律失常的AUC为0.839，敏感度为0.618，特异度为0.929；LVEF与瘢痕质量两个指标联合预测心肌梗死后MVA的AUC为0.848，敏感度为0.688，特异度为0.857。结论: 心肌瘢痕对预测心肌梗死后MVA发生的效能较LVEF更高，有望成为心肌梗死后患者预后评估的另一项预测指标。
关键词： 心肌梗死/病理生理学;  磁共振成像;  心律失常, 心性/诊断;  心室功能, 左;  心肌/病理学;  瘢痕;  预测    
Abstract:

Objective: To assess the predictive value of myocardial scar mass in malignant ventricular arrhythmia (MVA) after myocardial infarction. Methods: Thirty myocardial infarction patients with complete electrophysiology and cardiac MRI data admitted from January 2012 to August 2017 were enrolled in the study. According to the results of intracavitary electrophysiological study, MVA developed in 16 patients (MVA group) and not developed in 14 patients (non-MVA group). The qualitative and quantitative analysis of left ventricular ejection fraction (LVFE) and scar mass was performed with CVI42 post-processing software and predictive value of myocardial scar and LVEF for MVA after myocardial infarction was analyzed using ROC curves. Results: LVEF in MVA group was significantly lower than that in non-MVA group, and scar mass in MVA group was significantly higher than that in non-MVA group (all P < 0.05). Regression analysis showed that LVEF (OR=1.580) and scar mass (OR=6.270) were risk factors for MVA after myocardial infarction. For predicting MVA, the area under ROC curve (AUC) of LVEF was 0.696 with a sensitivity of 0.786 and the specificity of 0.685; the AUC of the scar mass was 0.839 with a sensitivity was 0.618 and the specificity of 0.929; the AUC of LVEF combined with scar mass was 0.848 with a sensitivity of 0.688 and specificity of 0.857. Conclusion: Myocardial scar assessed by late gadolinium enhancement MRI is more effective than LVEF in predicting MVA after myocardial infarction.
Key words: Myocardial infarction    Magnetic resonance imaging    Arrhythmias, cardiac/diagnosis    Ventricular function, left    Myocardium/pathology    Cicatrix    Forecasting
收稿日期: 2019-05-05 出版日期: 2020-01-04
:  R445.2  
基金资助: 国家自然科学基金(81873908);浙江省医药卫生科技计划(2018KY170)
通讯作者: 胡红杰,赵振华     E-mail: 494429508@qq.com;hongjiehu@zju.edu.en;zhao2075@163.com
作者简介: 郭丹玲(1988—), 女, 硕士, 住院医师, 主要从事心脏磁共振研究; E-mail: 494429508@qq.com; https://orcid.org/0000-0002-6959-4930
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郭丹玲
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吕桑英
黄亚男
蒋汝红
蒲彩玲
倪虹霞

引用本文:

郭丹玲,胡红杰,赵振华,吕桑英,黄亚男,蒋汝红,蒲彩玲,倪虹霞. 心肌瘢痕对慢性心肌梗死后恶性室性心律失常发生的预测价值[J]. 浙江大学学报（医学版）, 2019, 48(5): 511-516.

GUO Danling,HU Hongjie,ZHAO Zhenhua,LYU Sangying,HUANG Yanan,JIANG Ruhong,PU Cailing,NI Hongxia. Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction. J Zhejiang Univ (Med Sci), 2019, 48(5): 511-516.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.10.08    或    http://www.zjujournals.com/med/CN/Y2019/V48/I5/511

组别n男性体质指数(kg/m2)年龄(岁)高血压糖尿病吸烟饮酒高血脂脑梗死心肌梗死家族史
“—”无相关数据；MVA：恶性室性心律失常.
诱发出MVA组1611(68.8)23.4±3.854±139(56.3)5(31.3)5(31.3)3(18.8)7(43.8)3(18.8)3(18.8)
未诱发出MVA组147(50.0)23.8±3.157±86(42.9)3(21.4)2(14.3)3(20.0)4(28.6)2(14.3)0(0.0)
t/χ2值—-1.4180.595-0.5180.0481.0811.467-0.1771.286-0.139-0.139
P值—＞0.05＞0.05＞0.05＞0.05＞0.05＞0.05＞0.05＞0.05＞0.05＞0.05
表 1  是否诱发出MVA患者基线资料比较
组别nLVEF (%)EDV (mL)ESV (mL)左心室心肌质量(g)
“—”无相关数据；MVA：恶性室性心律失常；LVEF：左心室射血分数；EDV：舒张末期容积；ESV：收缩末期容积.
诱发出MVA组1634±14196±46146±61161±65
未诱发出MVA组1444±13163±3284±34129±35
t值—-2.709-2.9223.2821.793
P值—＜0.05＜0.05＜0.05＞0.05
表 2  是否诱发出MVA患者左心室心功能参数及心肌质量比较
组别n瘢痕质量(g)瘢痕质量百分比(%)灰区质量(g)灰区容积百分比(%)
“—”无相关数据；MVA：恶性室性心律失常.
诱发出MVA组1633±1032±1041±2138±20
未诱发出MVA组1426±724±733±1431±13
t值—3.4742.6080.8964.030
P值—＜0.05＜0.05＞0.05＞0.05
表 3  是否诱发出MVA患者延迟强化参数比较
变量回归系数OR值P值
性别-0.1590.853＞0.05
体质指数-0.1780.837＞0.05
年龄-0.1280.880＞0.05
高血压-0.1560.856＞0.05
糖尿病-0.0890.915＞0.05
吸烟-0.1950.823＞0.05
饮酒-0.0870.917＞0.05
高血脂-0.0360.965＞0.05
脑梗死-0.0030.997＞0.05
心肌梗死家族史-0.1080.898＞0.05
左心室心肌质量-0.1330.876＞0.05
灰区质量-0.2340.792＞0.05
左心室射血分数0.4631.580＜0.05
瘢痕质量1.8366.270＜0.05
表 4  心肌梗死患者发生恶性室性心律失常相关危险因素的多因素Logistic回归分析结果
图 1  左心室射血分数和瘢痕质量预测恶性心律失常的ROC曲线
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