| Objective:Clinical studies have shown that the transmural myocardial fibrosis is significantly related to heart failure and cardiogenic mortality.In patients with myocardial infarction,transmural myocardial fibrosis can lead to significant ventricular remodeling,heart failure,malignant arrhythmias,etc.,and is generally considered to be closely related to sudden cardiac death.Early identification and quantitative analysis of myocardial fibrosis is very important.Method to evaluate myocardial fibrosis currently has the following three kinds: 1)Delayed gadolinium enhancement cardiovascular magnetic resonance imaging(CMR-LGE),as the gold standard for the evaluation of myocardial fibrosis,has adverse reactions such as contrast agent allergic reaction and renal damage.It requires high equipment configuration,high cost,high requirement for the duration of examination on patients’ heart rate and cardiac function,and contraband exists in patients with metal implants.2)Cardiac ultrasound: In late 2016,the contrast enhanced ultrasound model was used to scan the heart and evaluate myocardial fibrosis,forming Echocardiography scar imaging(Escar),but it is not clear whether it can be used to evaluate myocardial fibrosis in the early stage(7 days)after myocardial infarction.3)Serological markers:ⅠType collagen carboxy-terminal peptide(PICP)and Type III procollagen amino-terminal peptide(PIIINP)are classic serum markers of myocardial collagen metabolism.This study aims to explore early detection methods for myocardial fibrosis in patients after myocardial infarction,including e SCAR,ECG ST segment fall rate and serum markers,which are valuable in the diagnosis of cardiac fibrosis,and provide new ideas for early clinical evaluation of myocardial fibrosis.Methods:We collected 42 patients with acute ST-segment elevation myocardial infarction(STEMI)who were admitted to the emergency department of cardiology in the First Affiliated Hospital of Chongqing Medical University received coronary angiography and Percutaneous coronary intervention(PCI)within 12 hours after the onset of pain.The ST segment resolution(STR)of the ECG was recorded at emergency admission and 24 hours after PCI,and the clinical baseline case data were collected.7 days after PCI: CMR-LGE was performed to evaluate the location,transmural(thickness),and area of the myocardial scar,and a bull’s eye map of cardiac muscle segments was drawn.The location of myocardial scar was evaluated by e SCAR,and a bull’s eye map of cardiac segments was drawn.Serum PICP concentration was determined by ELISA.Compared with the gold standard CMR-LGE,the evaluation value of electrocardiogram(ECG),ultrasonic e SCAR and serum PICP in myocardial scar(myocardial fibrosis)was explored.Results:The results showed as follows: 1)Among the 42 STEMI patients,41 cases(97.6%)had cardiac scar detected by CMR-LGE on the7 th day after PCI,and all patients(100%)had myocardial scar detected by e SCAR.The findings of e SCAR matched the area of myocardial scar detected by CMR-LGE,but the scar segments were not completely overlaps.Due to ultrasonic signal-to-noise ratio,image limitation and other factors,e SCAR cannot accurately quantify the transmural and size of scar.However,e SCAR can detect cardiac fibrosis with thin endocardium missed by CMR-LGE.2)Compared with CMR-LGE,the sensitivity and specificity of STR in predicting myocardial transmural scar were higher(96% and 88%,respectively),the area under the curve was 0.92,and STR cutoff value was 40.15%.3)Multiariate Logistic regression analysis showed that STR was an important independent risk factor for the formation of transmural scar after myocardial infarction.4)There was a significant negative correlation between the percentage of ST segment decline and the thickness(r=-0.838,P<0.001)and the size(r=-0.714,P<0.001)of myocardial scar.5)Serum PICP concentration was significantly higher in patients with transmural myocardial scar than in patients with non-transmural myocardial scar(P<0.001).6)40 months after PCI,compared with the non-transmural myocardial scar group,the readmission rate and the incidence of supraventricular premature beats,ventricular premature beats and short ventricular tachycardia in the transmural myocardial scar group all showed an increasing trend,but there was no statistical difference.It may be related to our small sample size.Two patients(2/16)died in the transmural cardiac scar group,while no patients(0/26)died in the non-transmural cardiac scar group.Conclusion:1)e SCAR has a high consistency with CMR-LGE in detecting the location of myocardial fibrosis.However,due to image limitations and other factors,it is unable to accurately evaluate the transmural property andsizeof scar.2)The 24-hour ECG ST segment fall of<40.15% in STEMI patients after PCI can be used as a simple,convenient,and non-invasive technical means to provide early clinical information with diagnostic significance for transmural myocardial fibrosis within 7 days after myocardial infarction.3)Serum PICP concentration in STEMI patients 7 days after PCI can be used as an indicator of the tendency of transmural development of myocardial scar.Each of the three methods for early detection of myocardial fibrosis in STEMI patients after PCI has its own advantages and disadvantages,but simple,convenient and non-invasive STR in ECG is worthy of clinical promotion. |
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