Assessment of collateralized myocardium with Cardiac Magnetic Resonance (CMR): transmural extent of infarction but not angiographic collateral vessel filling determines regional function and perfusion in collateral-dependent myocardium.
Assessment of collateralized myocardium with Cardiac Magnetic Resonance (CMR): transmural extent of infarction but not angiographic collateral vessel filling determines regional function and perfusion in collateral-dependent myocardium.
复制标题
用心脏磁共振 (CMR) 评估侧支心肌：梗塞的透壁程度而非血管造影侧支血管充盈程度决定了侧支依赖性心肌的区域功能和灌注。
DOI：
10.1016/j.ijcard.2006.08.036
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发表时间：
2007
影响因子：
3.5
通讯作者：
Nabauer,Michael
中科院分区：
文献类型：
--
作者：
Muehling,Olaf;Jerosch-Herold,Michael;Cyran,Clemens;Huber,Armin;Schoenberg,Stefan;Reiser,Maximilian;Steinbeck,Gerhard;Nabauer,Michael
造影侧支血管充盈仅限于评价侧支依赖性心肌。我们假设，定量评估局部心肌功能，灌注和存活与心脏磁共振（CMR）增加了补充信息血管造影的侧支心肌。方法30例患者进行了一个慢性闭塞的冠状动脉和没有进一步的血流限制狭窄，以评估跨壁扩展的梗死（TEI），静息灌注和腺苷诱导的充血和局部室壁增厚（RWT）期间的灌注，在侧支依赖性和顺行灌注心肌。采用冠状动脉造影和Rentrop分级（0-3级）评价侧支循环。（1.08±0.22 ml/min/g），充血（2.21±0.73 ml/min/g）和RWT（4.0±2.6 mm）与顺向灌注心肌相似（静息1.14±0.20和充血2.46±0.82 ml/min/g，RWT 4.3±1.7 mm）。在15例侧支依赖性心肌TEI ≥50%的患者中，静息灌注和充血以及RWT显著低于顺行灌注心肌（静息0.84±0.19，p<0.001和充血1.34±0.43 ml/min/g，p<0.001; RWT 1.0±1.0 mm，p<0.0001）。TEI与静息或充血灌注或RWT呈负相关。相反，与Rentrop分级差的患者（0-1）相比，良好（2-3）患者的静息灌注和充血以及侧支依赖性心肌的RWT没有差异。TEI与Rentrop分级之间无相关性。结论：如果梗死的透壁范围有限（<50%），则侧支依赖性心肌的功能和灌注得以保留。这与血管造影侧支血管充盈无关。因此，CMR为侧支血管的血管造影标准评估增加了补充信息。
BACKGROUNDAngiographic collateral vessel filling is limited to evaluate collateral-dependent myocardium. We hypothesize, that quantitative assessment of regional myocardial function, perfusion and viability with Cardiac Magnetic Resonance (CMR) adds complementary information to angiography of collateralized myocardium.METHODSCMR was performed in 30 patients with one chronic occluded coronary artery and no further flow limiting stenosis to assess transmural extend of infarction (TEI), resting perfusion and perfusion during adenosine-induced hyperemia and regional wall thickening (RWT) in collateral-dependent and antegradely-perfused myocardium. Collateral vessels were evaluated by angiography and the Rentrop grade (0–3).RESULTSIn 15 patients with <50% TEI in collateral-dependent myocardium resting perfusion (1.08±0.22 ml/min/g), hyperemia (2.21±0.73 ml/min/g) and RWT (4.0±2.6 mm) were similar to antegradely-perfused myocardium (rest 1.14±0.20 and hyperemia 2.46±0.82 ml/min/g, RWT 4.3±1.7 mm). In 15 patients with ≥50% TEI in collateral-dependent myocardium resting perfusion and hyperemia as well as RWT were significantly lower (rest 0.84±0.19, p<0.001 and hyperemia 1.34±0.43 ml/min/g, p<0.001; RWT 1.0±1.0 mm, p<0.0001) compared to antegradely-perfused myocardium. There was an inverse correlation between TEI and resting or hyperemic perfusion or RWT. In contrary, resting perfusion and hyperemia as well as RWT in collateral-dependent myocardium were not different between patients with good (2–3) compared to patients with poor Rentrop grade (0–1). There was no correlation between TEI and Rentrop grade.CONCLUSIONFunction and perfusion in collateral-dependent myocardium are preserved, if transmural extent of infarction is limited (<50%). This is independent of their angiographic collateral vessel filling. Thus, CMR adds complementary information to angiographic standard assessment of collateral vessels.