Cardiac Magnetic Resonance With Edema Imaging Identifies Myocardium at Risk and Predicts Worse Outcome in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
Cardiac Magnetic Resonance With Edema Imaging Identifies Myocardium at Risk and Predicts Worse Outcome in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
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DOI：
10.1016/j.jacc.2010.01.047
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发表时间：
2010-06-01
影响因子：
24
通讯作者：
Ambrosio, Giuseppe
中科院分区：
文献类型：
--
作者：
Raman, Subha V.;Simonetti, Orlando P.;Ambrosio, Giuseppe
目的探讨非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者心肌水肿的发生率及其意义。识别有心肌风险的患者可以提高早期侵入性策略的有效性。心脏磁共振（CMR）可以显示水肿心肌缺血，但还没有被用来评估NSTE-ACS patients.Methods前瞻性纳入100例连续的NSTE-ACS患者进行30分钟CMR，包括T2加权水肿成像和冠状动脉造影前的晚期钆增强。结果在88例充分的CMR研究中，57例（64.8%）显示心肌水肿。87.7%的水肿阳性患者存在需要血运重建的阻塞性CAD，而25.8%的水肿阴性患者存在需要血运重建的阻塞性CAD（p < 0.001）。通过校正晚期钆增强、灌注和室壁运动评分后的多元logistic回归分析，TIMI风险评分不能预测梗阻性CAD。相反，T2评分增加1 U，随后冠状动脉血运重建的几率增加5.70倍（95%置信区间：2.38至13.62，p < 0.001）。调整肌钙蛋白I峰值后，与无水肿的患者相比，有水肿的患者在NSTE-ACS后6个月内发生心血管事件或死亡的风险更高（风险比：4.47，95%置信区间：1.00至20.03; p = 0.050）。识别危险心肌可能有助于指导适当的患者进行早期侵入性治疗。（J Am科尔心脏病学杂志2010; 55：2480-8）（C）美国心脏病学会基金会2010年
Objectives The aim of this study was to define the prevalence and significance of myocardial edema in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Background Most patients with NSTE-ACS undergo angiography, yet not all have obstructive coronary artery disease (CAD) requiring revascularization. Identifying patients with myocardium at risk could enhance the effectiveness of an early invasive strategy. Cardiac magnetic resonance (CMR) can demonstrate edematous myocardium subjected to ischemia but has not been used to evaluate NSTE-ACS patients.Methods One hundred consecutive patients with NSTE-ACS were prospectively enrolled to undergo 30-min CMR, including T2-weighted edema imaging and late gadolinium enhancement before coronary angiography. Clinical management including revascularization decision-making was performed without CMR results.Results Of 88 adequate CMR studies, 57 (64.8%) showed myocardial edema. Obstructive CAD requiring revascularization was present in 87.7% of edema-positive patients versus 25.8% of edema-negative patients (p < 0.001). By multiple logistic regression analysis after adjusting for late gadolinium enhancement, perfusion, and wall motion scores, TIMI risk score was not predictive of obstructive CAD. Conversely, an increase in T2 score by 1 U increased the odds of subsequent coronary revascularization by 5.70 times (95% confidence interval: 2.38 to 13.62, p < 0.001). Adjusting for peak troponin-I, patients with edema showed a higher hazard of a cardiovascular event or death within 6 months after NSTE-ACS compared with those without edema (hazard ratio: 4.47, 95% confidence interval: 1.00 to 20.03; p = 0.050).Conclusions In NSTE-ACS patients, rapid CMR identifies reversibly injured myocardium due to obstructive CAD and predicts worse outcomes. Identifying myocardium at risk may help direct appropriate patients toward early invasive management. (J Am Coll Cardiol 2010; 55: 2480-8) (C) 2010 by the American College of Cardiology Foundation