Hyper-acute cardiovascular magnetic resonance T1 mapping predicts infarct characteristics in patients with ST elevation myocardial infarction
Hyper-acute cardiovascular magnetic resonance T1 mapping predicts infarct characteristics in patients with ST elevation myocardial infarction
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DOI：
10.1186/s12968-019-0593-9
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发表时间：
2020-01-09
影响因子：
6.4
通讯作者：
Choudhury, Robin P.
中科院分区：
文献类型：
--
作者：
Alkhalil, Mohammad;Borlotti, Alessandra;Choudhury, Robin P.
背景：急性心肌梗死患者经皮冠状动脉介入治疗后的心肌恢复是可变的，损伤的程度和严重程度难以预测。我们试图研究心血管磁共振T1定位在st段抬高型心肌梗死（STEMI）治疗后早期确定心肌损伤的作用。方法STEMI患者在首次经皮介入治疗（PPCI）后3小时内行3t心血管磁共振（CMR）检查。T1测图确定急性心肌损伤的程度（危险面积为%左心室，AAR）和严重程度（AAR的平均T1值），并将其与晚期钆增强（LGE）和微血管阻塞（MVO）联系起来。将3 h内心肌损伤特征与24 h的变化进行比较，预测最终梗死面积。结果共纳入40例患者。PPCI后3小时内平均T1值AAR >= 1400 ms的患者在24小时（33% +/- 14 vs. 18% +/- 10, P = 0.003）和6个月（27% +/- 9 vs. 12% +/- 9, P < 0.001）时LGE较大，MVO发生率和程度较高（85% vs. 40%, P = 0.016）和[4.0 (0.5-9.5)% vs. 0 (0-3.0)%, P = 0.025]。平均T1值是急性LGE （β 0.61, 95%CI 0.13 ~ 1.09, P = 0.015）、MVO范围（β 0.22, 95%CI 0.03 ~ 0.41, P = 0.028）和最终梗死面积（β 0.63, 95%CI 0.21 ~ 1.05, P = 0.005）的独立预测因子。受体工作特征分析显示，在3小时内（而非24小时）获得的AAR T1值预测大面积梗死（LGE > 9.5%），在最佳截止时间为1400 ms时（曲线下面积，AUC为0.88,P = 0.006），预测值为100%阳性。结论超急性期AAR T1值（PPCI后3小时内，而非24小时）在24小时和6个月的随访中预测了更大的MVO范围和梗死面积。延迟24h CMR扫描不能替代超急性平均T1在判断梗死特征方面的重要价值。
Background Myocardial recovery after primary percutaneous coronary intervention in acute myocardial infarction is variable and the extent and severity of injury are difficult to predict. We sought to investigate the role of cardiovascular magnetic resonance T1 mapping in the determination of myocardial injury very early after treatment of ST-segment elevation myocardial infarction (STEMI). Methods STEMI patients underwent 3 T cardiovascular magnetic resonance (CMR), within 3 h of primary percutaneous intervention (PPCI). T1 mapping determined the extent (area-at-risk as %left ventricle, AAR) and severity (average T1 values of AAR) of acute myocardial injury, and related these to late gadolinium enhancement (LGE), and microvascular obstruction (MVO). The characteristics of myocardial injury within 3 h was compared with changes at 24-h to predict final infarct size. Results Forty patients were included in this study. Patients with average T1 values of AAR >= 1400 ms within 3 h of PPCI had larger LGE at 24-h (33% +/- 14 vs. 18% +/- 10, P = 0.003) and at 6-months (27% +/- 9 vs. 12% +/- 9; P < 0.001), higher incidence and larger extent of MVO (85% vs. 40%, P = 0.016) & [4.0 (0.5-9.5)% vs. 0 (0-3.0)%, P = 0.025]. The average T1 value was an independent predictor of acute LGE (beta 0.61, 95%CI 0.13 to 1.09; P = 0.015), extent of MVO (beta 0.22, 95%CI 0.03 to 0.41, P = 0.028) and final infarct size (beta 0.63, 95%CI 0.21 to 1.05; P = 0.005). Receiver-operating-characteristic analysis showed that T1 value of AAR obtained within 3-h, but not at 24-h, predicted large infarct size (LGE > 9.5%) with 100% positive predictive value at the optimal cut-off of 1400 ms (area-under-the-curve, AUC 0.88, P = 0.006). Conclusion Hyper-acute T1 values of the AAR (within 3 h post PPCI, but not 24 h) predict a larger extent of MVO and infarct size at both 24 h and 6 months follow-up. Delayed CMR scanning for 24 h could not substitute the significant value of hyper-acute average T1 in determining infarct characteristics.