| Objectives:1.5T or 3.0T cardiac magnetic resonance(CMR)are used to perform cardiac magnetic resonance(CMR)examination within 3-6 months after coronary angiography whether or not percutaneous coronary intervention(PCI)treatment in patients with acute coronary syndrome(ACS).Myocardial perfusion parameters,cardiac function parameters and fibrosis parameters are obtained to evaluate coronary microcirculation and left ventricular function in ACS patients.Methods: A total of 106 patients with acute coronary syndrome(ACS)and patients without coronary heart disease who were hospitalized in the Department of Cardiology of our hospital from July 2015 to December 2022 were selected as the research objects,including acute ST-segment elevation myocardial infarction(STEMI)patients(n=17),acute non-ST-segment elevation myocardial infarction(NSTEMI)patients(n=24),unstable angina(UA)patients(n=34),patients without coronary heart disease as the control group(n=31).The ACS group patients were further divided into two groups: the group receiving percutaneous coronary intervention(PCI)after coronary angiography(n=31)and the group not receiving PCI after coronary angiography(n=44).Collecting all patients general clinical data,laboratory indexes(blood routine,full set of biochemistry),and conventional parameters of transthoracic echocardiography.All patients underwent CMR examination within 3-6 months after surgery to obtain myocardial microcirculation perfusion parameters : time to peak(tpeak),relative peak signal intensity(RSIpeak),and maximum upslope of myocardial(Slopemax);cardiac function parameters : left ventricular ejection fraction(LVEF),left ventricular enddiastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular cardiac output(LVCO),left ventricular stroke volume(LVSV),left ventricular cardiac index(LVCI);fibrosis parameters : late gadolinium enhancement(LGE),extracellular volume fraction(ECV).To explore the value of CMR in evaluating coronary microcirculation parameters,cardiac function parameters and myocardial fibrosis parameters in ACS patients.SPSS 26.0 statistical software was used to analyze the collected data,and P< 0.05 was considered statistically significant.Results: 1.The ACS group(n=75)and the non-coronary heart disease group(n=31)to compare the cardiac magnetic resonance resting first-pass perfusion parameters of the myocardial 16 segments,the tpeak of 4,5,8,10,11,14-16 segments in ACS group was longer than the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The RSIpeak of the 1-4,6-9,11,12,16 segments in the ACS group was lower than the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The Slopemax of the 1-16 segments in the ACS group was lower than the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The above results showed that the ACS group compared with the noncoronary heart disease group,the local contrast agent inflow time of the corresponding segment of the myocardium was prolonged,the relative peak concentration was reduced,and the increase rate of contrast agent concentration was slowed down(that is,tpeak was prolonged,RSIpeak and Slopemax were reduced),suggesting that different types of ACS patients have different degrees of coronary microvascular dysfunction.2.In the ACS group,the myocardial infarction group(n=41),the UA group(n=34)and the non-coronary heart disease group(n=31)were compared the cardiac magnetic resonance resting first-pass perfusion parameters of the myocardial 16 segments.The tpeak of the 4,10,11,14,16 segments in the myocardial infarction group was longer than the non-coronary heart disease group,and the difference was statistically significant(P< 0.05).The RSIpeak of the 8,11,16 segments in the myocardial infarction group was lower than the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The Slopemax of the 1-16 segments in the myocardial infarction group was lower than that in the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The tpeak of the 10,14 segments in the UA group was longer than the non-oronary heart disease group,and the difference was statistically significant(P < 0.05).The RSIpeak of the 11 segment in the UA group was lower than that in the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The Slopemax of the 1-16 segments in the UA group was lower than the non-coronary heart disease group,and the difference was statistically significant(P < 0.05).The above results suggest that in myocardial infarction group and UA group the tpeak is prolonged and the RSIpeak,Slopemax are decreased compared with noncoronary heart disease group.3.In the ACS group,including 17 patients of STEMI group,24 patients of NSTEMI group and 34 patients of UA group,the three subgroups resting first-pass perfusion parameters of the myocardial 16 segments were compared;there was no significant difference in tpeak,RSIpeak and Slopemax between the three subgroups(P > 0.05).4.Among the 31 patients in the PCI group,there were 12 patients of STEMI(group C),8 patients of NSTEMI(group D),and 11 patients of UA(group E).The cardiac magnetic resonance resting first-pass perfusion parameters of the myocardial 16 segments were compared with the three subgroups.There was no significant difference in the tpeak of 1-16 segments among the three subgroups(P > 0.05).There was no significant difference in the RSIpeak between group C and group D(P > 0.05).The Slopemax of 4,6,15 segments in group C was higher than that in group D,and the difference was statistically significant(P < 0.05).The RSIpeak of 3 segment in group C was higher than group E,and the difference was statistically significant(P < 0.05).The Slopemax of 15 segment in group C was higher than group E,and the difference was statistically significant(P < 0.05).A total of 26 patients(83.90%)in the three subgroups were LGE positive.The above results suggest that patients in the PCI group still have coronary microvascular dysfunction in 3-6 months after surgery.5.In the three subgroups of PCI group,the ECV value of group C was higher than group D and group E,and the difference was statistically significant(P < 0.05).The ECV value of group D was higher than group E,and the difference was statistically significant(P < 0.05).The results showed that the myocardial fibrosis in STEMI group was more serious than NSTEMI group and UA group(P < 0.05).There were 26 patients with late gadolinium enhancement in the PCI group,and the overall native T1 value of group C was higher than group D and group E,and the difference was statistically significant(P < 0.05).The above results suggest that myocardial fibrosis is more serious in STEMI patients.Conclusions: 1.The ACS patients(including STEMI,NSTEMI,UA)have different degrees of coronary microvascular dysfunction.2.In the PCI group(including STEMI,NSTEMI,UA)still have coronary microvascular dysfunction in 3-6 months after surgery.3.In the PCI group,the ECV value of STEMI group was higher than NSTEMI group and UA group,suggesting that myocardial fibrosis in STEMI patients may be more serious. |
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