| [Objective] Application of cardiac MR imaging techniques, to explore the heart of nuclear magneticresonance in diabetic patients with coronary heart disease assessment value; the use of cardiac magneticresonance imaging to explore the characteristics of diabetic patients with heart damage, and provide atheoretical basis for the early treatment of cardiovascular complications of diabetes; diabetes reasonabletreatment and cardiovascular disease, primary and secondary prevention to provide a theoretical support andlooking for possible new way to provide a broader space.[Methods]1). Apparatus and its equipment: All the patients were Germany, the Siemens Sonata1.5T MRI scanner,supine, using a dedicated cardiac phased array coil and ECG gating.2) Scanning steps: First, the shape and heart function tests, and re-perfusion scan delay of10-15minutes ofactivity scanning (delayed enhancement).Scan parameters:(1) left ventricular fractional film scanning (true FISP) sequence: TR45ms, TE1.5ms, flipangle15o, FOV285mm!380mm, reconstruction matrix119!256,15-19seconds per scan, successivebreath-hold scan. Mainly used for heart long axis of the surface (two-chamber, four chamber) collection, androutine cardiac short axis cine MRI for wall motion score.(2) left ventricular short axis myocardial perfusion imaging (EPI sequence): TR188ms TE1.0ms flip angle15o,FOV293mm!360mm, reconstruction matrix156!256, scan time of about40s, per scan with50phasesingle breath-hold scan.5-10s after the start of the scan using the high-pressure syringe elbow intravenouscontrast agent gadolinium spray for acid melamine (Gd-DTPA), the amount of8ml, speed of5ml/s, the total0.1-0.2mmol/kg acquisition of myocardial perfusion obsolete phase MR images. Perfusion image acquisitionafter repeated routine cardiac cine MRI acquisition used for the wall motion score after reperfusion.(3) Left ventricular delay scan: to give1ml/s spray by the elbow of the intravenous contrast agent gadoliniumdelayed scan (activity) for the acid melamine12ml. The sequence variables tirR: the TR (ms):750; TE (ms):405; average number of:1; inspire the number of:1; anti-rotation:30o; Parallel Acquisition: None; scanningdirection: two chamber, four chamber and short axis; thickness (mm):8; interlayer spacing (mm)1.6; FOV:400mm!75mm; matrix:119!256; phase-encoding direction: A>> P; scan time (s):19s. Image acquisitionand the whole ECG monitoring.3) cardiac MRI image processing: the coronary artery of the left ventricular short axis plane myocardial bloodsupply, refer to the AHA to provide left ventricular17-segment division method, the left ventricularmyocardium by the coronary artery is divided into six segments. All the image information the applicationARUGS workstation software package for processing and analysis, observation and evaluation of leftventricular segmental wall motion, function and myocardial perfusion, and the activity of the situation.4) visual qualitative method: cardiac function by computer processing, perfusion and active image by theradiologist line, double-blind independent observations of the three do not understand the clinical data analysis,to determine consensus standards.[Results]1. Proportionality test: A balanced test: diabetic patients with coronary heart disease group,diabetes group, coronary heart disease group, normal control group between the two groups and group2compared with male to female ratio, average age, smoking, drinking than height, weight, weight index (bodymass index, BMI), blood pressure and blood lipids constitute a match, there was no significant difference (p>0.05). 2.2diabetic patients with coronary artery disease and myocardial ischemic lesions: by the inspection anddiabetic patients with coronary artery disease and coronary heart disease, perfusion abnormalities weresignificantly different (P <0.05).3. Diabetic patients with coronary artery disease and myocardial infarction lesions: by the inspection anddiabetic patients with coronary artery disease and coronary heart disease, perfusion abnormalities weresignificantly different (P <0.05).4. Cardiac function compared1) the cardiac contractile function:(1) EF: the main effects of diabetic factors not statistically significant (F=3.709, P=0.057), statisticallysignificant main effect of coronary heart disease factors, coronary heart disease in patients with EF valueslower than the non-crown heart disease patients (F=79.984, P <0.01), but the interaction between the twofactors was statistically significant (F=3.591, P=0.061).(2) SV: the main effect of the factors of diabetes was statistically significant (F=3.136, P=0.079),statistically significant main effect of factors with coronary artery disease, coronary heart disease in patientswith SV value is lower than the non-coronary heart disease patients (F=6.211, P=0.014), and the interactionbetween the two factors was statistically significant, when the diabetic factors allows patients with coronaryartery disease SV value was further reduced (F=8.481, P=0.005).(3) CO: the main effects of diabetic factors not statistically significant (F=2.955, P=0.088), statisticallysignificant main effect of factors with coronary artery disease, coronary heart disease in patients with COvalues lower than the non-coronary heart disease patients (F=6.145P=0.015), but the interaction betweenthe two factors was statistically significant (F=3.851, P=0.052).2) Left ventricular wall thickening:(1) the base: the main effects of diabetic factors not statistically significant(F=1.030, P=0.312), coronary heart disease factors, the main effect is not statistically significant (F=79.984P <0.01), but the interaction between the two factors was statistically significant (F=1.623, P=0.205).(2) the middle of the Ministry: the main effects of diabetic factors was statistically significant, patients withdiabetes pars intermediate wall thickening rate in the non-diabetic patients (F=5.751, P=0.018), nosignificant main effect of coronary heart disease factors (F=0.329, P=0.567), and the interaction between thetwo factors was statistically significant when the presence of coronary heart disease factors allows patientswith diabetes pars intermediate wall thickening was further increased (F=8.481, P=0.005).(3) the apex: the main effects of diabetic factors not statistically significant (F=0.050, P=0.823),statistically significant main effect of factors with coronary artery disease, coronary heart disease in patientswith apical wall thickening rate lower than the non-crown heart disease patients (F=19.093, P=P <0.01), butthe interaction between the two factors was statistically significant (F=2.570, P=0.112).3) diastolic function:(1) PFR: the main effects of diabetic factors was statistically significant, patients withdiabetes PFR values lower than non-diabetic patients (F=21.878, P <0.01), the main effect of the factors ofcoronary heart disease was statistically significant, coronary heart disease patients with PFR values lower thanthe non-coronary heart disease patients (F=20.787, P <0.01), but the interaction between the two factors wasnot statistically significant (F=2.364, P=0.127).(2) TPFR: the main effects of diabetic factors wasstatistically significant, patients with diabetes TPFR values than non-diabetic patients (F=9.003, P=0.003),coronary heart disease factors, the main effect was statistically significant, in patients with coronary heartdisease TPFR value higher than the non-coronary heart disease patients (F=7.678, P=0.007), but theinteraction between the two factors was not statistically significant (F=0.006, P=0.938).[Conclusion](1) Diabetes can increase coronary heart disease the probability of myocardial ischemia andinfarction.(2) Diabetes associated with coronary heart disease, left ventricular function slow down the fillingspeed, filling time; left ventricular wall thickening, decreased ventricular compliance;(3) cardiac MR can be used as clinical screening of diabetic patients with suspected coronary heart disease check method.(4) ofdiabetes and coronary heart disease, early diagnosis and the severity of judgment, provide the basis for clinicaltreatment. |
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