| Objective:Chronic Total coronary Occlusion(((Chronic Total Occlusion,CTO))means at least one coronary Occlusion,coronary blood flow TIMI grade 0,and no history of acute myocardial infarction in the past 3 months.Myocardial fibrosis(Myocardial Fibrosis,MF)is triggered during the progression of CTO.The more severe the MF is,the worse the cardiac function is.If the myocardial area innervated by the diseased vessels has formed MF,and revascularization is performed,there is no significant benefit to the patients.Therefore,it is very important to distinguish the occurrence of MF and evaluate the degree of MF in clinic.The aim of this research is to analyze the risk factors of MF in patients with CTO,forecast the incidence of MF and the class of blood marrow fracture,and offer more ample information for clinicians to enact treatment plans and assess prognosis.Methods:From May,2019 to November,2020,66 patients who were diagnosed as CTO,without percutaneous stent implantation after coronary angiography were admitted to the cardiovascular department of our hospital.The general clinical data of the patients were collected and echocardiography was used to detect the systolic and diastolic function of the left ventricle.At the same time,the cardiac magnetic resonance examination was improved after coronary angiography,and gadolinium contrast delayed contrast-enhanced imaging was used to determine the occurrence of MF.Then the patients were divided into fibrotic group and non-fibrotic group,and the risk factors that could measure MF were found by statistical method.Then,according to the results of MRI,the patients in the fibrosis group were further divided into the transmural group and the non-transmural group,and the risk factors that could predict the occurrence of transmural penetration were found by comparing the parameters between the groups.Results:1.Analysis of fibrosis group and non-fibrosis group in patients with CTO:1)grouping of patients: 48 patients in the fibrosis group(72.7%),18 patients in the non-fibrosis group(27.3%),38 males in the fibrosis group(79.2%),with an average age of(60.73 ± 8.75)years,and 13 men in the non-fibrosis group(72.2%).The average age was(60.00 ± 11.53)years.The percentage of fibrotic volume in the fibrosis group was 7.14(3.71-15.63)%.2)comparison of general clinical conditions:1 factors related to coronary artery disease: the incidence of myocardial infarction history,PCI operation history,three-vessel disease and LAD-related CTO vessels in the fibrosis group was higher than that in the non-fibrosis group,but there was no significant difference in other parameters(P > 0.05).2 comparison of blood biochemical indexes: the blood biochemical indexes such as c Tn I,hs-TNT,Glu,Hb A1 C and K + in the fibrosis group were higher than those in the non-fibrosis group(P < 0.05),but there was no significant difference in other parameters(P > 0.05).3)comparison of left ventricular function: the ratio of Mitral average E’in fibrotic group was higher than that in non-fibrotic group(P < 0 05),but there was no significant difference in other parameters(P > 0 05).4)predicting the risk factors of myocardial fibrosis:1 univariate Logistic regression analysis showed that myocardial infarction history,three-vessel lesions,LAD-related CTO vessels,K +,Mitral average Epicure e’ and other parameters were related to myocardial fibrosis in CTO patients,but there was no significant difference in other parameters(P > 0.05).2Multivariate Logistic regression analysis showed that three-vessel disease was an independent risk factor for myocardial fibrosis in patients with CTO.The sensitivity and specificity of three-vessel disease in predicting myocardial fibrosis were 82% and50%,respectively.2.Analysis of whether or not to penetrate the wall in the fibrotic group of patients with CTO:1)grouping of patients: 32 patients(66.7%)in the transmural fibrosis group and 16patients(33.3%)in the non-transmural fibrosis group;25 males(78.1%)in the transmural fibrosis group,with an average age of(60.47 ±8.92)years;13 males in the non-transmural fibrosis group(87.5%),with an average age of(61.25 ± 8.68)years.Compared with the non-transmural fibrosis group,the percentage of fibrotic volume in the transmural fibrosis group was significantly increased(13.88% VS2.71% P < 0.001).2)comparison of general clinical conditions:1 Coronary artery related factors: the SYNTAX Ⅰ score in the transmural group was significantly higher than that in the non-transmural group,but there was no significant difference in other parameters.2 comparison of blood biochemical indexes: BNP was significantly higher in the nonpermeable group than that in the non-transmural group(P < 0.05),but there was no significant difference in other parameters(P > 0.05).3)comparison of left ventricular function: there was no significant difference in echocardiographic parameters between the two groups(P > 0.05).4)to predict the risk factors of transmural penetration in myocardial fibrosis group:1 univariate Logistic regression analysis showed that the SYNTAX Ⅰ score and BNP in the transmural group were related to the transmural fibrosis(P < 0.10),but there was no significant difference in the other parameters(P > 0.05).2Multivariate Logistic regression analysis showed that SYNTAX Ⅰ score was an independent risk factor for transmural fibrosis.The results of 3ROC curve analysis showed that the sensitivity and specificity of predicting transmural fibrosis with SYNTAX Ⅰ score ≥ 34 were 44% and 100%,respectively.[area under the curve(AUC)= 0.68,P = 0.019].Conclusion:1.3-vessel lesions are independent risk factors for the formation of myocardial fibrosis in patients with CTO.2.SYNTAX Ⅰ score is an independent risk factor for transmural penetration in patients with CTO myocardial fibrosis.when SYNTAXⅠscore ≥ 34,the sensitivity and specificity of diagnosing myocardial fibrosis are 44% and 100% respectively. |
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