The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.
The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.
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DOI：
10.1056/nejm200011163432003
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发表时间：
2000-11-16
影响因子：
158.5
通讯作者：
Judd, RM
中科院分区：
文献类型：
--
作者：
Kim, RJ;Wu, E;Judd, RM
背景：最近的研究表明，造影剂注射后的磁共振成像（MRI）可用于区分可逆性和不可逆性心肌缺血损伤，而不考虑壁运动的程度或梗死的年龄。我们假设磁共振造影增强的结果可以用来预测冠状动脉疾病患者血运重建术后异常心室收缩区域是否会改善。方法：对50例脑室功能障碍患者行手术或经皮血管重建术前进行钆增强MRI检查。假设高增强区的跨壁范围代表无活力心肌的跨壁范围。41例患者在血运重建术前后，通过电影MRI检测相同部位的局部收缩程度。结果：50例患者中有40例在血运重建术前显示心肌组织高强化。在所有高增强患者中，高增强区域与非高增强区域的图像强度差大于6 SD。在血运重建术之前，分析的2093个心肌节段中有804个（38%）有异常的收缩力，694个（33%）有一些区域的高强化。在对所有804个功能障碍节段的分析中，随着血运重建术前跨壁高增强程度的增加，血运重建术后区域收缩改善的可能性逐渐降低
Background: Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent of wall motion or the age of the infarct. We hypothesized that the results of contrast-enhanced MRI can be used to predict whether regions of abnormal ventricular contraction will improve after revascularization in patients with coronary artery disease.Methods: Gadolinium-enhanced MRI was performed in 50 patients with ventricular dysfunction before they underwent surgical or percutaneous revascularization. The transmural extent of hyperenhanced regions was postulated to represent the transmural extent of nonviable myocardium. The extent of regional contractility at the same locations was determined by cine MRI before and after revascularization in 41 patients.Results: Contrast-enhanced MRI showed hyperenhancement of myocardial tissue in 40 of 50 patients before revascularization. In all patients with hyperenhancement the difference in image intensity between hyperenhanced regions and regions without hyperenhancement was more than 6 SD. Before revascularization, 804 of the 2093 myocardial segments analyzed (38 percent) had abnormal contractility, and 694 segments (33 percent) had some areas of hyperenhancement. In an analysis of all 804 dysfunctional segments, the likelihood of improvement in regional contractility after revascularization decreased progressively as the transmural extent of hyperenhancement before revascularization increased (P