Clinically unrecognized myocardial infarction detected at MR imaging may not be associated with atherosclerosis
Clinically unrecognized myocardial infarction detected at MR imaging may not be associated with atherosclerosis
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DOI：
10.1148/radiol.2451061664
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发表时间：
2007-10-01
期刊：
影响因子：
19.7
通讯作者：
Ahlstroem, Hakan
中科院分区：
文献类型：
--
作者：
Barbier, Charlotte Ebeling;Bjerner, Tomas;Ahlstroem, Hakan
目的：前瞻性研究磁共振（MR）成像检测到的临床未识别的心肌梗死（UMIs）具有与已识别的心肌梗死（RMI）相似的动脉粥样硬化发病机制的假设是否得到支持。材料和方法：在伦理委员会批准并获得知情同意后，对随机选择的248例患者进行钆增强全身MR血管造影和后期增强MR成像70 岁受试者（123 名女性，125 名男性）。影像包括主动脉、颈动脉、肾动脉和下肢至脚踝的动脉，但不包括冠状动脉。晚期增强 MR 成像中出现心肌梗死 (MI) 疤痕的受试者被分类为 RMI (n = 11)（在医院诊断为 MI 的患者）或 UMI (n = 49)（在医院未诊断为 MI 的患者）。全身 MR 血管造影中任何血管出现 50% 或更高的管腔狭窄被认为代表严重的动脉粥样硬化。通过超声检查测量颈总动脉的内膜中层厚度。测量C反应蛋白水平，并估计冠心病风险。观察者对之前的任何结果都视而不见。采用chi(2)方差检验分析和Bonferroni校正进行统计分析。结果：无MI疤痕组和UMI组之间所有测量参数均无显着差异，但与无MI疤痕组相比，RMI组的参数显着增加（P < .05）。 49 例 UMI 中的 42 例和 11 例 RMI 中的 9 例位于左心室下外侧段。结论：MR 成像检测到的 UMI 可能与 RMI 具有不同的发病机制，或者可能具有相同的发病机制但可能在早期出现。
Purpose: To prospectively investigate whether there is support for the hypothesis that clinically unrecognized myocardial infarctions (UMIs) detected at magnetic resonance (MR) imaging have an atherosclerotic pathogenesis similar to that of recognized myocardial infarctions (RMIs).Materials and Methods: After ethics committee approval and informed consent were obtained, gadolinium-enhanced whole-body MR angiography and late-enhancement MR imaging were performed in 248 randomly chosen 70-year-old subjects (123 women, 125 men). Imaging included the aorta and the carotid, renal, and lower limb arteries to the ankle, but not the coronary arteries. Subjects with myocardial infarction (MI) scars at late-enhancement MR imaging were classified as having RMI (n = 11) (those with a diagnosis of MI at the hospital) or UMI (n = 49) (those without a diagnosis of MI at the hospital). The presence of 50% or higher luminal narrowing in any vessel at whole-body MR angiography was considered to represent significant atherosclerosis. Intima-media thickness of the common carotid artery was measured with ultrasonography. C-reactive protein level was measured, and coronary heart disease risk was estimated. Observers were blinded to any previous results. The chi(2) test analysis of variance, and Bonferroni correction were used for statistical analyses.Results: None of the measured parameters differed significantly between the group without MI scars and the UMI group, but parameters were significantly increased in the RMI group (P < .05) compared with those in the group without MI scars. Forty-two of 49 UMIs and nine of 11 RMIs were located within inferolateral segments of the left ventricle.Conclusion: MR imaging-detected UMIs might have a different pathogenesis from that of RMIs or may have the same pathogenesis but may manifest at an earlier stage.