Edema as a Very Early Marker for Acute Myocardial Ischemia A Cardiovascular Magnetic Resonance Study
Edema as a Very Early Marker for Acute Myocardial Ischemia A Cardiovascular Magnetic Resonance Study
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DOI：
10.1016/j.jacc.2008.10.065
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发表时间：
2009-04-07
影响因子：
24
通讯作者：
Friedrich, Matthias G.
中科院分区：
文献类型：
--
作者：
Abdel-Aty, Hassan;Cocker, Myra;Friedrich, Matthias G.
目的本研究旨在确定心肌水肿成像是否能在不可逆损伤发生前识别急性心肌缺血。背景急性心肌缺血的早期识别是一个挑战。方法我们研究了15只狗的连续T-2加权和电影成像在基线，在短暂的冠状动脉闭塞长达35分钟，再灌注后在1.5T磁共振成像系统中进行。晚期钆增强和肌钙蛋白测量用于评估不可逆损伤的存在。心肌含水量测定，以评估心肌edge.Results我们始终观察到一个高T-2信号强度匹配区与新发区域运动不能28 +/- 4分钟后，实验性冠状动脉闭塞的透壁面积。此时，缺血心肌和远端心肌之间的对比噪声比从1.0 ± 2.0显著增加到12.8 ± 9.6（p < 0.003），再灌注后进一步增加到15.8 ± 10.3（与基线相比p < 0.004）。在该时间窗内，未观察到心肌晚期钆增强或肌钙蛋白升高。缺血节段心肌含水量持续升高（68.9 +/- 2% vs. 67.0 +/- 2%; p < 0.004），并且该差异与T-2图像中的对比噪声比显著相关结论我们首次提供了T-2-水肿的加权心血管磁共振成像在不可逆损伤发生之前检测急性缺血性肌细胞损伤。T2加权心血管磁共振成像可以作为一个非常有用的诊断标记物，在临床上，如不稳定型心绞痛或进展性梗死。（J Am科尔心脏病学杂志2009; 53：1194-201）（C）美国心脏病学会基金会2009年
Objectives This study was designed to determine whether imaging myocardial edema would identify acute myocardial ischemia before irreversible injury takes place.Background Early identification of acute myocardial ischemia is a diagnostic challenge.Methods We studied 15 dogs with serial T-2-weighted and cine imaging at baseline, during transient coronary occlusion of up to 35 min, and after reperfusion in a 1.5-T magnetic resonance imaging system. Late gadolinium enhancement and troponin measurements were used to assess for the presence of irreversible injury. Myocardial water content was measured to assess myocardial edema.Results We consistently observed a transmural area of high T-2 signal intensity matching areas with new onset regional akinesia 28 +/- 4 min after experimental coronary artery occlusion. At this time, the contrast-to-noise ratio between the ischemic and remote myocardium had significantly increased from 1.0 +/- 2.0 to 12.8 +/- 9.6 (p < 0.003), which further increased after reperfusion to 15.8 +/- 10.3 (p < 0.004 compared with baseline). Neither myocardial late gadolinium enhancement nor troponin elevation were noted at this time window. Myocardial water content of the ischemic segments was consistently higher (68.9 +/- 2% vs. 67.0 +/- 2%; p < 0.004) than in remote segments and the difference correlated significantly to the contrast-to-noise ratio in T-2 images (p < 0.04).Conclusions We provide the first evidence that T-2-weighted cardiovascular magnetic resonance imaging of edema detects acute ischemic myocyte injury before the onset of irreversible injury. T-2-weighted cardiovascular magnetic resonance imaging may serve as a very useful diagnostic marker in clinical settings such as unstable angina or evolving infarction. (J Am Coll Cardiol 2009; 53: 1194-201) (C) 2009 by the American College of Cardiology Foundation