Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention.
Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention.
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DOI：
10.1007/s10554-009-9499-1
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发表时间：
2010-01
影响因子：
2.1
通讯作者：
van Rossum, A. C.
中科院分区：
文献类型：
--
作者：
Beek, A. M.;Nijveldt, R.;van Rossum, A. C.
再灌注可能会导致红细胞通过严重受损的内皮壁外渗而导致心肌内出血（IMH）。本研究的目的是评估初次经皮介入治疗后患者 IMH 与梗死面积、微血管阻塞 (MVO) 和功能相关的临床意义。 45 名患者在首次急性心肌梗塞初次支架植入后 1 周和 4 个月接受了心血管 MR 成像 (CMR)。 T2加权自旋回波成像（T2W）用于评估梗塞相关水肿和IMH，延迟增强（DE）用于评估梗塞面积和MVO。电影 CMR 用于评估基线和 4 个月随访时的左心室容量和功能。在 22 名 (49%) 患者中，IMH 被检测为 T2W 图像上高信号强度区域核心的信号衰减区域。 IMH 患者梗死面积更大、左心室容量更大、射血分数更低。 T2W 缺血区域的高信号外围和低信号核心之间的对比噪声比 (CNR) 与 CKMB 峰值、总梗死面积和 MVO 大小相关。使用单变量分析，CNR 预测基线时的射血分数 (β = −0.62，P = 0.003) 和随访时的射血分数 (β = −0.84，P < 0.001)。然而，经过多变量分析，基线射血分数和 MVO 的存在是预测随访时功能变化的唯一参数。大多数再灌注心肌梗死后发生 MVO 的患者均发现 IMH。它与梗塞面积、MVO 和功能的标志物密切相关，但除 MVO 外不具有预后意义。
Reperfusion may cause intramyocardial hemorrhage (IMH) by extravasation of erythrocytes through severely damaged endothelial walls. The purpose of the study was to evaluate the clinical significance of IMH in relation to infarct size, microvascular obstruction (MVO) and function in patients after primary percutaneous intervention. Forty-five patients underwent cardiovascular MR imaging (CMR) 1 week and 4 months after primary stenting for a first acute myocardial infarction. T2-weighted spin-echo imaging (T2W) was used to assess infarct related edema and IMH, and delayed enhancement (DE) was used to assess infarct size and MVO. Cine CMR was used to assess left ventricular volumes and function at baseline and at 4 months follow-up. In 22 (49%) patients, IMH was detected as areas of attenuated signal in the core of the high signal intensity region on T2W images. Patients with IMH had larger infarcts, higher left ventricular volumes and lower ejection fraction. Contrast-to-noise ratio (CNR) between hyperintense periphery and the hypo-intense core of the T2W ischemic area correlated to peak CKMB, total infarct size and MVO size. Using univariable analysis, CNR predicted ejection fraction at baseline (β = −0.62, P = 0.003) and follow-up (β = −0.84, P < 0.001). However, after multivariable analysis, baseline ejection fraction and presence of MVO were the only parameters that predicted functional changes at follow-up. IMH was found in the majority of patients with MVO after reperfused myocardial infarction. It was closely related to markers of infarct size, MVO and function, but did not have prognostic significance beyond MVO.
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影响因子：
24
作者：
Nijveldt, Robin;Beek, Aernout M.;van Rossum, Albert C.
通讯作者：
van Rossum, Albert C.
影响因子：
37.8
作者：
FUJIWARA, H;ONODERA, T;HAMASHIMA, Y
通讯作者：
HAMASHIMA, Y
影响因子：
6.4
作者：
Nijveldt, Robin;Beek, Aernout M.;van Rossum, Albert C.
通讯作者：
van Rossum, Albert C.
影响因子：
37.8
作者：
Aletras, AH;Tilak, GS;Arai, AE
通讯作者：
Arai, AE
影响因子：
39.3
作者：
van den Bos, Ewout J.;Baks, Timo;Wielopolski, Piotr A.
通讯作者：
Wielopolski, Piotr A.