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心磁图在冠状动脉微循环障碍诊断与疗效评估中的作用

The role of magnetocardiography in the diagnosis and efficacy assessment of coronary microvascular dysfunction

    摘要
  • 摘要:
    目的 探讨心磁图在冠状动脉微循环障碍（coronary microvascular dysfunction, CMVD）中的无创诊断标准，及其在CMVD药物治疗动态评估中的价值。
    方法 连续性纳入2024年9月至2025年3月因胸闷胸痛就诊于复旦大学附属中山医院，且冠状动脉造影未见显著狭窄的患者。以基于冠状动脉造影的微循环阻力指数（coronary angiography-derived index of microcirculatory resistance, caIMR）为金标准，将患者分为微循环正常组（caIMR≤40 U）和CMVD组（caIMR＞40 U）。采用国产心磁图仪（MD-U041001，漫迪医疗）行心磁图检测。CMVD组患者接受腺苷治疗，并于用药后复查心磁图。分析两组患者心磁图差异参数，并建立诊断模型。通过受试者工作特征（receiver operating characteristic, ROC）曲线分析诊断模型的价值。
    结果 共纳入311例患者，微循环正常组135例、CMVD组176例。CMVD组男性比例高于微循环正常组（61.9% vs 47.4%, P＝0.012），高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）水平低于微循环正常组（1.16±0.31）mmol/L vs（1.24±0.29）mmol/L, P＝0.029。11个心磁图参数在两组间的差异有统计学意义（P＜0.05）。其中，mfm_QR_epav、mfm_RS_epmse、space_zeroRTrot水平升高，mfm_QR_v1水平降低是CMVD的独立预测因子（P＜0.05）。基于11个心磁图参数的诊断模型曲线下面积（area under the curve, AUC）为0.688（95%CI 0.629～0.747），联合临床危险因素（男性、吸烟史、HDL-C）的整合模型AUC为0.701（95%CI 0.643～0.759）。CMVD组患者接受腺苷治疗后，mfm_QR_epav（P＝0.010）、mfm_RS_sad（P＝0.013）和mfm_RS_epmse（P＝0.046）水平显著下降。
    结论 基于心磁图参数构建的诊断模型对CMVD具有良好识别能力；腺苷干预后心磁图参数的动态变化，可作为评估CMVD治疗效果的潜在客观指标。

     

    Abstract:
    Objective To explore the non-invasive diagnostic criteria of magnetocardiography (MCG) for coronary microvascular dysfunction (CMVD), and its value in dynamically assessing drug treatment for CMVD.
    Methods Patients who presented with chest tightness or chest pain at Zhongshan Hospital, Fudan University from September 2024 to March 2025 were consecutively enrolled, and all of whom had non-obstructive coronary arteries on angiography. Using the coronary angiography-derived index of microcirculatory resistance (caIMR) as the gold standard, patients were divided into a normal microcirculation group (caIMR≤40 U) and a CMVD group (caIMR＞40 U). MCG testing was performed using a domestic device (MD-U041001, Mind Medical). Patients in the CMVD group received adenosine treatment and underwent repeat MCG after medication. Differences in MCG parameters between the two groups were analyzed, and a diagnostic model was established. The value of the diagnostic model was analyzed using receiver operating characteristic (ROC) curves.
    Results A total of 311 patients were included, with 135 in the normal microcirculation group and 176 in the CMVD group. The CMVD group had a significantly higher proportion of males (61.9% vs 47.4%, P＝0.012), and lower high-density lipoprotein cholesterol (HDL-C) levels (1.16±0.31 mmol/L vs 1.24±0.29 mmol/L, P＝0.029) than the normal group. Eleven MCG parameters showed significant differences between the two groups (P＜0.05), among which increased values of mfm_QR_epav, mfm_RS_epmse, space_zeroRTrot, as well as decreased value of mfm_QR_v1 were independent predictors of CMVD. The diagnostic model based on these 11 MCG parameters yielded an area under the curve (AUC) of 0.688 (95%CI 0.629-0.747). The integrated diagnostic model combining clinical risk factors (male, smoking history, HDL-C) with MCG parameters had an AUC of 0.701 (95%CI 0.643-0.759). After adenosine treatment, patients in the CMVD group showed significant decreases in mfm_QR_epav (P＝0.010), mfm_RS_sad (P＝0.013), and mfm_RS_epmse (P＝0.046).
    Conclusions The model based on MCG parameters demonstrates good diagnostic ability for CMVD; dynamic changes in MCG parameters following adenosine intervention may serve as potential objective indicators for evaluating microcirculatory treatment efficacy.

     

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