| Part 1:Correlative study of gray zone of myocardialinfarction with transmural degree of infarctionObjective:The high incidence of major adverse events after myocardial infarction(MI)is the main reason for the poor long-term prognosis after myocardial infarction.In this study,the volume and mass of GZ were quantitatively analyzed by using Circle Cardiovascular Imaging(CVI42)to explore the correlation between the volume and mass of GZ and the degree of myocardial transmural penetration of infarcted myocardium and the size of infarcted core,so as to gain a deeper understanding of GZ.Methods:Sixty patients with MI were enrolled in the department of cardiology of the second affiliated hospital of kunming medical university from March 2015 to January 2019.All patients underwent 3.0t cardiac magnetic resonance imaging(CMRI)examination(Achieva,Philips),including cardiac film sequence,cardiac perfusion,and Late Gadolinium Enhancement magnetic resonance imaging(LGE-MRI).The short axes of different layers in delayed gadolinium imaging of all patients were measured with CVI42 software,the mass and volume of GZ and IC were obtained,and the percentage of myocardial transmesion degree of infarction was calculated,and the 17-segment distribution diagram of related parameters of IC,GZ and myocardial transmesion degree of infarction was drawn(Polar Map).The obtained data were statistically analyzed according to the following groups:? According to the percentage of myocardial transmural degree of infarction,it was divided into Transmural myocardial infarction group(>50%)and Non-transmural myocardial infarction group(50%).?according to the percentage of transmural degree of infarction,the degree of transmural infarction was divided into 4 groups with increasing grade,and then the differences of GZ volume and mass in different groups were compared;? comparison of GZ volume with quality and IC volume with quality each patient to explore the correlation between the two.Results:(1)the volume and mass of GZ of the non-transmural myocardial infarction group and the transmural myocardial infarction group were statistically analyzed According to the analysis,The median of volume of GZ of the transmural infarction group was 3.48(1.70,6.00)ml,The median of mass of GZ was 3.66(1.76,6.28)g,The median of volume of GZ of the non-transmural infarction group was 0.59(0.40,0.90)ml,the GZ mass rank sum was 0.620(0.425,0.940)ml,P<0.001,and the difference was statistically significant.(2)correlation analysis was conducted between the volume and mass of GZ and the four groups of patients with different degrees of transmural infarction,and the results showed that Gradel:The median of volume of GZ was 0.46ml(0.32,0.52)ml,The median of mass of GZ was 0.48(0.35,0.55)g.Grade2:The median of volume of GZ was 0.87(0.67,1.25)ml,The median of mass of GZ was 0.91(0.71,1.31)g,Grade3:The median of volume of GZ was 1.74(1.12,3.16)ml,The median of mass of GZ was 1.83g(1.18,3.32)g,Grade4:The volume of GZ was 5.91(4.82,12.13),The median of mass of GZ was 6.22(:5.06,12.73)g,rs-v=0.850,rs-m=O.851,P<0.001,and the differences were statistically significant.(3)correlation analysis was performed between GZ volume and mass and IC volume and mass,respectively,The median of volume of GZ was 1.20(0.54,3.88)ml.The median of mass of GZ was 1.26(0.57,4.08)g,The median of volume of IC was 2.51(0.61,8.23)ml,and median of the mass of IC was 2.63(0.64,8.71)g.rs-v=0.850,rs-m=0.851,P<0.001.and the difference was statistically significant.Conclusion:The volume and mass of GZ were different with the degree of myocardial infarction penetration.The higher the degree of myocardial infarction penetration was,the greater the volume and mass of GZ was,and it increased with the degree of myocardial infarction penetration.The volume and mass of GZ are positively correlated with the volume and mass of IC,that is,the larger IC is,the larger GZ is.Part 2:Correlation between gray zone and pathological Q wave in transmural myocardial infarctionObjective:Current studies have shown that patients with QW have worse clinical prognosis than patients with non-q wave,and it is not clear whether there is a correlation between GZ and pathological QW.Therefore,this study quantitatively analyzed the volume and quality of GZ to explore its correlation with pathological Q wave.Methods:30 patients with grade 3-4 MI were enrolled in the department of cardiology of the second affiliated hospital of kunming medical university from March 2015 to January 2019,and were diagnosed as grade 3-4 MI by CMR examination and CVI post-treatment analysis(the degree of wall penetration was greater than 50%).All patients were divided into pathological QW group and non-QW group according to ecg(and CMR examination within one week).Wilcoxon was used to completely randomly design the rank sum test of the two sample data for statistical analysis of the size of GZ in the two groupsResults:The pathologic QW group and non QW in GZ for the statistical analysis,the volume and quality of obtained in pathologic QW groups:the median of volume of GZ was 3.41(1.12.5.48)ml,the median of quality of GZ was 3.58(1.18.5.76)g,the non QW groups:the median of volume of GZ was 8.73(4.24,13.11 6)ml,the median of quality of GZ was 9.79(4.46,13.32)g,Z=-2.841,P<0.05,the difference was statistically significant.Conclusion:At level 3 or 4 patients with MI,GZ volume and quality in the patients with Non-QW than sick patients with rational QW,possible mechanism could be the pathologic QW formation mechanism is not produce ecg vector myocardial necrosis,and GZ is not entirely necrotic myocardium,which activity of myocardium,can produce electrical activity,enough to be a large abnormal pathological QW.Part 3:Explore the relationship between the gray zone ofmyocardial infarction and corresponding segmentalmyocardial strainObjective:At present,CMR myocardial strain tracking(CMR-FT)has been applied in strain studies of various cardiac diseases,but there is still a lack of studies on GZ,and the correlation between GZ and strain is not clear.In this study,CVI42 software was used to measure the volume and mass of segments of myocardial infarction gray zone,and the strain of corresponding segments was quantified by cmr-ft to explore the correlation between GZ and myocardial strain.Methods:Patients with myocardial infarction who were admitted to the department of cardiology of the second affiliated hospital of kunming medical university from August 2015 to January 2019 and confirmed by CMR were included in the study,and there was no IC in the GZ segment of all patients on the CVI42 software.A total of 30 patients were included in the study.Using the CMR-FT technology come to GZ segment(no IC)peak of the Longitudinal strain parameters(LS),peak Radial strain parameters(RS)and peak Circumferential strain parameters(CS).Spearman rank correlation was used to analyze the correlation between GZ segment volume and mass size and strain.Results:A total of 480 segments,GZ was present in 32 segments,including 16 LAD segments,11 LCX segments,5 RCA segments,The median of volume of GZ is 4.86(2.64,10.94)ml,The median of mass of GZ is 5.10(2.77,11.00)g,The median of corresponding segment LS is-8.00%(-11.88,-5.05%),median of RS is 16.10%(13.20,23.08%),and median of CS is-10.80%(-16.13.-7.43%).(1)correlation analysis was performed between the GZ volume and mass size at rest and the LS of the corresponding myocardial segment,respectively.The results showed that rs-v=0.043 and rs-m=0.020,all P=0.341.and the differences were not statistically significant.(2)correlation analysis was conducted between the GZ volume and mass size at rest state and the corresponding myocardial RS value at the corresponding stage.The results showed that rs-v=-0.230 and rs-m=-0.171,P-0.753,and the differences were not statistically significant.(3)correlation analysis was conducted between GZ volume and mass under resting state and the value of myocardial CS at the corresponding stage,and the results showed that rs-v-c=0.039 and rs-m-c=0.026,P=0.613,and the differences were not statistically significant.Conclusion:There was no statistical correlation between the volume and mass of GZ segment and the three strain values of corresponding segmental myocardium.At present,the effect of infarct core(IC)on strain has been clarified,but the effect of GZ on strain still needs further study. |
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