Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post-Reperfused ST-Elevation Myocardial Infarction.
Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post-Reperfused ST-Elevation Myocardial Infarction.
复制标题
自动细胞外容量分数测绘可深入了解再灌注后 ST 段抬高型心肌梗死左心室重塑的病理生理学。
DOI：
10.1161/jaha.116.003555
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发表时间：
2016-07-11
影响因子：
5.4
通讯作者：
Hausenloy DJ
中科院分区：
文献类型：
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作者：
Bulluck H;Rosmini S;Abdel-Gadir A;White SK;Bhuva AN;Treibel TA;Fontana M;Gonzalez-Lopez E;Reant P;Ramlall M;Hamarneh A;Sirker A;Herrey AS;Manisty C;Yellon DM;Kellman P;Moon JC;Hausenloy DJ
再灌注 ST 段抬高型心肌梗死 (STEMI) 患者的远端心肌是否在不良左心室 (LV) 重构中发挥作用仍不清楚。我们的目的是使用自动细胞外体积分数 (ECV) 绘图来研究远端 (ECVR emote) 和梗塞心肌 (ECVI nfarct) 的 ECV 变化是否影响左心室重塑。 50 名前瞻性招募的再灌注 STEMI 患者中，有 48 名患者在 4±2 天时完成了心血管磁共振检查，40 名患者在 5±2 个月时进行了随访扫描。二十名健康志愿者作为对照。获得了原始 T1、T2 和 ECV 的平均分段值。不良左心室重构定义为左心室舒张末期容积增加≥20%。与对照组相比，急性扫描的 ECVR 表情更高（27.9±2.1% vs 26.4±2.1%；P=0.01）。与没有发生不良左心室重构的患者相比，8 名患者发生了不良左心室重构，且 ECVR 急性发作率较高（29.5±1.4% vs 27.4±2.0%；P=0.01），并且在随访时仍然较高（28.6±1.5% vs 26.6±2.1%；P=0.02）。 ECVR emote 较高和心肌挽救指数 (MSI) 较低的患者与不良 LV 重塑显着相关，与 T1Remote、T1Core 和微血管阻塞无关，而 ECVI 梗塞较高则与室壁运动恢复较差显着相关。 再灌注 STEMI 患者的 ECVR 情绪急剧增加。那些有不良左心室重塑的患者具有较高的急性 ECVR 情绪，并且在随访时仍高于没有不良左心室重塑的患者。较高的 ECVR 表情和较低的 MSI 与不良左室重构显着相关，而 ECVI 梗塞较高的节段恢复室壁运动的可能性较小。
Whether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling. Forty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery. ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.