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双能CT左室心肌碘图技术联合BNP对AMI后发生心力衰竭的预测价值

张焕 韩旭 崔斌 陈杰 于海涛 王志群

张焕, 韩旭, 崔斌, 等. 双能CT左室心肌碘图技术联合BNP对AMI后发生心力衰竭的预测价值[J]. CT理论与应用研究, 2022, 31(3): 373-382. DOI: 10.15953/j.ctta.2021.068
引用本文: 张焕, 韩旭, 崔斌, 等. 双能CT左室心肌碘图技术联合BNP对AMI后发生心力衰竭的预测价值[J]. CT理论与应用研究, 2022, 31(3): 373-382. DOI: 10.15953/j.ctta.2021.068
ZHANG H, HAN X, CUI B, et al. Predictive value of dual-energy CT left ventricular iodinogram combined with plasma BNP in the development of heart failure after AMI[J]. CT Theory and Applications, 2022, 31(3): 373-382. DOI: 10.15953/j.ctta.2021.068. (in Chinese)
Citation: ZHANG H, HAN X, CUI B, et al. Predictive value of dual-energy CT left ventricular iodinogram combined with plasma BNP in the development of heart failure after AMI[J]. CT Theory and Applications, 2022, 31(3): 373-382. DOI: 10.15953/j.ctta.2021.068. (in Chinese)

双能CT左室心肌碘图技术联合BNP对AMI后发生心力衰竭的预测价值

doi: 10.15953/j.ctta.2021.068
基金项目: 中国航天科工集团公司2018年医疗卫生科研项目(双源双能CT心肌灌注成像联合心脏磁共振成像评价冠心病患者心肌活性的对照研究(2018-LCYL-002))。
详细信息
    作者简介:

    张焕:女,航天中心医院影像科主治医师,主要从事心血管影像诊断工作,E-mail:zhanghuansunny@126.com

    崔斌:男,硕士,航天中心医院影像科主任医师,主要从事神经影像及心血管影像诊断研究,E-mail:cuibinmail@sina.com

  • 中图分类号: R  814

Predictive Value of Dual-energy CT Left Ventricular Iodinogram Combined with Plasma BNP in the Development of Heart Failure after AMI

  • 摘要: 目的:探讨双能量CT左室心肌碘图技术及血浆B型利钠肽(BNP)水平对急性心肌梗死(AMI)患者发生心力衰竭(HF)及严重程度的早期诊断及预测价值。方法:选取2018年1月至2019年12月本院收治的AMI患者,完成双能量冠状动脉CTA检查及血浆BNP检查,入院治疗1周内评估患者心功能分级。通过双能量冠脉CTA检查测量心肌碘含量用以评价患者CT心肌灌注情况。分析患者心肌碘含量、左心室射血分数及BNP水平指标间的相关性,对比HF患者不同Killip心功能分级组间心肌灌注情况、LVEF及BNP水平的差异。结果:共有115例AMI患者入组,其中42例纳入HF组,73例非HF组。两组间的心肌碘浓度、LVEF及BNP的差异均有统计学意义。梗死心肌碘浓度、LVEF与BNP水平呈负相关(r=−0.527、−0.674)。ROC曲线显示,心肌碘浓度联合BNP对于预测AMI后发生HF的AUC高于碘图、BNP的单独预测结果。42例AMI后HF患者不同Killip分级组之间,随着Killip分级的升高,血清BNP水平升高,LVEF及梗死心肌碘含量下降,并且不同分级组间BNP、LVEF、梗死心肌碘含量差异均有统计学意义。结论:双能量CT左室心肌碘图技术联合BNP水平对急性心肌梗死后心力衰竭的发生有预测价值,并与心力衰竭的临床严重程度有一定相关性。

     

  • 图  1  心肌碘浓度、LVEF与BNP相关性分析

    Figure  1.  Correlation analysis of myocardial iodine concentration, LVEF and BNP

    图  2  碘图、BNP及碘图联合BNP预测AMI后HF诊断的ROC曲线

    Figure  2.  ROC curve of diagnosis of HF after AMI was predicted by iodine map, BNP and iodine map combined with BNP

    图  3  男性患者,68岁。(a)(b)冠状动脉CTA 图像:左前降支管腔重度狭窄;(c)双能CT心肌灌注伪彩图:左心室第8、13、14、17节段灌注缺损;(d)左心室短轴位心肌碘图:缺损区碘浓度平均值为0.3 mg/mL

    Figure  3.  Male patient, 68 years old. (a) and (b) show CTA images of coronary arteries: Severe stenosis of the left anterior descending branch. (c) shows dual-energy CT pseudo-color image of myocardial perfusion: Perfusion defects in left ventricular segments 8, 13, 14 and 17. (d) shows short axial myocardial iodinogram of the left ventricle: The mean iodine concentration in the defect area was 0.3 mg/mL

    表  1  HF组与非HF组患者一般资料比较

    Table  1.   Comparison of general data between HF group and non-HF group

    基本情况组别 统计检验
    HF组(n=42)非HF组(n=73)χ2/tP
    年龄/岁   68.15±6.3259.90±7.12 4.3570.095
    男/女    24/1845/280.2250.635
    心肌梗死史/例 4183.9470.047
    高血压史/例  27430.3240.569
    糖尿病史/例 15240.0960.757
    高脂血症史/例19280.5220.470
    下载: 导出CSV

    表  2  两组CT心肌灌注及实验室检查情况

    Table  2.   CT myocardial perfusion and laboratory examination of the two groups

    检查项目组别统计检验
    HF组(n=42)非HF组(n=73)tP
    LVEF/%      39.85±6.23 60.14±5.31 18.5030.001
    心肌碘浓度/(mg/mL)1.43±1.01 3.43±0.8511.274<0.001
    BNP/(ng/L)    585.57±163.91360.16±87.28-8.2610.002
    下载: 导出CSV

    表  3  AMI后发生HF的危险因素分析

    Table  3.   Risk factors of HF after AMI

    检验变量标准误OR值95%CIP
    心梗病史 0.5930.7800.925~1.0180.408
    LVEF   0.1251.3701.015~1.6790.034
    BNP    0.1081.0850.987~1.0910.006
    心肌碘浓度0.4631.2760.679~2.3240.012
    下载: 导出CSV

    表  4  碘图、BNP及碘图联合BNP预测AMI后HF诊断效能的比较

    Table  4.   Comparison of diagnostic efficacy of iodine map, BNP and iodine map combined with BNP in predicting HF after AMI

    指标灵敏度/%特异度/%AUC
    碘图联合BNP预测88.178.10.926
    碘图81.072.60.863
    BNP78.667.10.757
    下载: 导出CSV

    表  5  不同Killip分级间心肌碘浓度、LVEF、BNP比较情况

    Table  5.   Comparison of myocardial iodine concentration, LVEF and BNP among different Killip grades

    分组例数心肌碘浓度/(mg/mL)LVEF/%BNP/(ng/L)
    非HF组733.42±0.85 60.14±5.31 360.16±87.48
    Killip Ⅱ级161.59±1.07ab41.52±5.93ab 424.13±118.73ab
    Killip Ⅲ级141.66±0.97ab40.43±4.28ab616.14±17.99ab
    Killip Ⅳ级120.88±0.59ab34.12±5.76ab765.16±78.94ab
     注:a.与非HF组比较,P<0.05;b.不同NYHA分级分组之间两两比较,P<0.05。
    下载: 导出CSV
  • [1] FACH A, BÜNGER S, ZABROCKI R, et al. Comparison of outcomes of patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention analyzed by age groups (<75, 75 to 85, and >85 years); (Results from the Bremen STEMI Registry)[J]. American Journal of Cardiology, 2015, 116(12): 1802−1809. doi: 10.1016/j.amjcard.2015.09.022
    [2] WEIR R, MCMURRAY J J V, VELAZQUEZ E J. Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: Prevalence, clinical characteristics, and prognostic importance[J]. American Journal of Cardiology, 2006, 97(10A): 13F−25F.
    [3] DELGADO C, M VÁZQUEZ, OCA R, et al. Myocardial ischemia evaluation with dual-source computed tomography: Comparison with magnetic resonance imaging[J]. Revista Espaola de Cardiología, 2013, 66(11): 864−870.
    [4] 董宁超, 程国杰, 张弓, 等. 血BNP浓度对急性心肌梗死患者心力衰竭的早期预测效果[J]. 解放军预防医学杂志, 2019,37(6): 163−164.

    DONG N C, CHENG G J, ZHANG G, et al. Effect of serum BNP concentration on early prediction of heart failure in patients with acute myocardial infarction[J]. Journal of Preventive Medicine of Chinese People's Liberation Army, 2019, 37(6): 163−164. (in Chinese).
    [5] ISLAM M N, ALAM M F, DEBNATH R C, et al. Correlation between Troponin-I and B-type natriuretic peptide level in acute myocardial infarction patients with heart failure[J]. Mymensingh Medical Journal, 2016, 25(2): 226−231.
    [6] RYBICKI F J, UDELSON J E, PEACOCK W F, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: A joint document of the american college of radiology appropriateness criteria committee and the american college of cardiology appropriate use criteria task force[J]. Journal of the American College of Cardiology, 2016, 67(7): 853−879. doi: 10.1016/j.jacc.2015.09.011
    [7] ROFFI M, PATRONO C, COLLET J P, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)[J]. European Heart Journal, 2016, 37(3): 267−315. doi: 10.1093/eurheartj/ehv320
    [8] KIM M S, LEE J H, KIM E J, et al. Korean guidelines for diagnosis and management of chronic heart failure[J]. Korean Circulation Journal, 2017, 47(5): 555−643. doi: 10.4070/kcj.2017.0009
    [9] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2014[J]. 中华心血管病杂志, 2014,42(2): 98−122. doi: 10.3760/cma.j.issn.0253-3758.2014.02.004

    Chinese Society of Cardiology, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for diagnosis and treatment of heart failure 2014[J]. Chinese Journal of Cardiology, 2014, 42(2): 98−122. (in Chinese). doi: 10.3760/cma.j.issn.0253-3758.2014.02.004
    [10] 毛懿, 杨跃进, 张健, 等. 急性心肌梗死患者血B型利钠肽水平与心功能的相关性和诊断心力衰竭的价值[J]. 中华心血管病杂志, 2009,37(3): 218−222. doi: 10.3760/cma.j.issn.0253-3758.2009.03.005

    MAO Y, YANG Y J, JIAN Z, et al. The relationship between plasma BNP level and the left ventricular dysfunction parameters in patients with acute myocardial infarction and its value in diagonosing heart failure[J]. Chinese Journal of Cardiology, 2009, 37(3): 218−222. (in Chinese). doi: 10.3760/cma.j.issn.0253-3758.2009.03.005
    [11] 李睿, 栾波, 段娜, 等. 辽西不同地区急性心肌梗死相关危险因素比较分析[J]. 中国循证心血管医学杂志, 2018,10(3): 300−303. doi: 10.3969/j.issn.1674-4055.2018.03.11

    LI R, LUAN B, DUAN N, et al. Comparative analysis of risk factors related to acute myocardial infarction in different areas of western Liaoning[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2018, 10(3): 300−303. (in Chinese). doi: 10.3969/j.issn.1674-4055.2018.03.11
    [12] 张胜豪, 刘恒亮, 毛磊, 等. 血清糖类抗原125及脑钠肽水平对心肌梗死后心力衰竭发生及严重程度的预测价值[J]. 中国动脉硬化杂志, 2019,27(1): 55−60. doi: 10.3969/j.issn.1007-3949.2019.01.011

    ZHANG S H, LIU H L, MAO L, et al. Predictive value of serum carbohydrate antigen 125 and brain natriuretic peptide levels in the occurrence and severity of heart failure after myocardial infarction[J]. Chinese Journal of Arteriosclerosis, 2019, 27(1): 55−60. (in Chinese). doi: 10.3969/j.issn.1007-3949.2019.01.011
    [13] 朱志远, 戴军, 王海燕, 等. 急性心肌梗死患者血清hs CRP/PAB、NT-pro BNP、LVEF水平与心力衰竭发生的相关性[J]. 中国医药导刊, 2019,21(7): 392−395. doi: 10.3969/j.issn.1009-0959.2019.07.003

    ZHU Z Y, DAI J, WANG H Y, et al. Correlation between serum hs CRP/PAB, NT-pro BNP, LVEF Levels and heart failure in patients with acute myocardial infarction[J]. Chinese Journal of Medicinal Guide, 2019, 21(7): 392−395. (in Chinese). doi: 10.3969/j.issn.1009-0959.2019.07.003
    [14] DANAD I, SZYMONIFKA J, SCHULMAN-MARCUS J, et al. Static and dynamic assessment of myocardial perfusion by computed tomography[J]. European Heart Journal Cardiovasc Imaging, 2016, 17(8): 836−844. doi: 10.1093/ehjci/jew044
    [15] 韩瑞娟, 孙凯, 李坤成, 等. 第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值[J]. 中华诊断学电子杂志, 2015,3(3): 17−21.

    HAN R J, SUN K, LI K C, et al. Diagnostic accuracy of the second generation dual-source dual-energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction[J]. Chinese Journal of Diagnostics (Electronic Edition), 2015, 3(3): 17−21. (in Chinese).
    [16] SCHWARZ F, RUZSICS B, SCHOEPF U J, et al. Dual-energy CT of the heart−Principles and protocols[J]. European Journal of Radiology, 2008, 68(3): 423−433. doi: 10.1016/j.ejrad.2008.09.010
    [17] HO K T, ONG H Y, TAN G, et al. Dynamic CT myocardial perfusion measurements of resting and hyperaemic blood flow in low-risk subjects with 128-slice dual-source CT[J]. European Heart Journal Cardiovasc Imaging, 2015, 16(3): 300−306. doi: 10.1093/ehjci/jeu200
    [18] NICCOLI G, SCALONE G, LERMAN A, et al. Coronary microvascular obstruction in acute myocardial infarction[J]. European Heart Journal, 2016, 37(13): 1024−1033. doi: 10.1093/eurheartj/ehv484
    [19] 马海彦, 王玉权, 谢光友, 等. 动态CT心肌灌注成像定量心肌血流量与ST段抬高心肌梗死患者肌钙蛋白水平及左心室功能受损的相关性[J]. 实用医学杂志, 2020,36(10): 1371−1375. doi: 10.3969/j.issn.1006-5725.2020.10.020

    MA H Y, WANG Y Q, XIE G Y, et al. Dynamic CT myocardial perfusion imaging with quantitative MBF correlated with troponin level and impaired left ventricular function in patients with ST− Segment elevation myocardial infarction[J]. Journal of Practical Medicine, 2020, 36(10): 1371−1375. (in Chinese). doi: 10.3969/j.issn.1006-5725.2020.10.020
    [20] MEINEL F G, PUGLIESE F, SCHOEPF U J, et al. Prognostic value of stress dynamic myocardial perfusion CT in a multicenter population with known or suspected coronary artery disease[J]. American Journal of Cardiology, 2017, 208(4): 761−769.
    [21] 赵娜, 高扬. 心脏功能学CT成像技术的研究及应用现状[J]. 中国循环杂志, 2020,35(11): 1139−1143. doi: 10.3969/j.issn.1000-3614.2020.11.016

    ZHAO N, GAO Y. Research and application status of CT imaging in cardiac function[J]. Chinese Circulation Journal, 2020, 35(11): 1139−1143. (in Chinese). doi: 10.3969/j.issn.1000-3614.2020.11.016
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出版历程
  • 收稿日期:  2021-12-20
  • 录用日期:  2022-02-16
  • 网络出版日期:  2022-03-05
  • 刊出日期:  2022-05-23

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