Assessment of Microvascular Obstruction and Prediction of Short-term Remodeling after Acute Myocardial Infarction: Cardiac MR Imaging Study
Assessment of Microvascular Obstruction and Prediction of Short-term Remodeling after Acute Myocardial Infarction: Cardiac MR Imaging Study
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DOI：
10.1148/radiol.2502080739
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发表时间：
2009-02-01
期刊：
影响因子：
19.7
通讯作者：
van Rossum, Albert C.
中科院分区：
文献类型：
--
作者：
Nijveldt, Robin;Hofman, Mark B. M.;van Rossum, Albert C.
目的：评价哪种心脏磁共振（MR）成像技术检测微血管阻塞（MVO）最能预测急性心肌梗死（MI）后左心室（LV）重构。材料和方法：本研究已获得当地伦理委员会批准;所有患者均签署了书面知情同意书。63例首次急性心肌梗死患者接受了初次支架置入术和最佳药物治疗，在心肌梗死后4-7天和4个月接受了电影MR成像。采用三种技术在基线时定性评估MVO的存在：（a）单次激发饱和恢复梯度回波首过灌注序列（早期低增强），平均时间，1.09分钟± 0.07（标准差）;（B）三维分段饱和恢复梯度回波序列（中度低增强），平均时间，2.17分钟+/- 0.26;（c）二维分段反转恢复梯度回波晚期钆增强序列（晚期低增强），平均时间，13.32分钟+/- 1.26。对比噪声比（CNRs）从梗死心肌和MVO区域的信噪比计算。单变量线性回归分析用于确定每种MR成像techniques.Results的预测值：早期低增强检测44（70%）的63例，中期低增强，在39（62%），和晚期低增强，在37（59%）。晚期低增强是左室舒张末期和收缩末期容积随时间变化的最强预测因子（分别为β = 14.3，r = 0.40，P = 0.001和β = 11.3，r = 0.44，P <0.001），而中期和晚期低增强对左室射血分数变化的预测价值相当（分别为β =-3.1，r =-0.29，P = 0.02和β =-2.8，r =-0.27，P = 0.04）。与其他序列相比，校正空间分辨率后的CNR在晚期增强时显著上级（P <0.001）。结论：通过使用心脏MR成像，晚期低增强是左室重构的最佳预后标志，梗死心肌和MVO区域之间的CNR最高。(C)RSNA，2008年
Purpose: To evaluate which cardiac magnetic resonance (MR) imaging technique for detection of microvascular obstruction (MVO) best predicts left ventricular (LV) remodeling after acute myocardial infarction (MI).Materials and Methods: This study had local ethics committee approval; all patients gave written informed consent. Sixty-three patients with first acute MI, treated with primary stent placement and optimal medical therapy, underwent cine MR imaging at 4-7 days and at 4 months after MI. Presence of MVO was qualitatively evaluated at baseline by using three techniques: (a) a single-shot saturation-recovery gradient-echo first-pass perfusion sequence (early hypoenhancement), mean time, 1.09 minutes +/- 0.07 (standard deviation) after contrast material administration; (b) a three-dimensional segmented saturation-recovery gradient-echo sequence (intermediate hypoenhancement), mean time, 2.17 minutes +/- 0.26; and (c) a two-dimensional segmented inversion-recovery gradient-echo late gadolinium enhancement sequence (late hypoenhancement), mean time, 13.32 minutes +/- 1.26. Contrast-to-noise ratios (CNRs) were calculated from the signal-to-noise ratios of the infarcted myocardium and MVO areas. Univariable linear regression analysis was used to identify the predictive value of each MR imaging technique.Results: Early hypoenhancement was detected in 44 (70%) of 63 patients; intermediate hypoenhancement, in 39 (62%); and late hypoenhancement, in 37 (59%). Late hypoenhancement was the strongest predictor of change in LV end-diastolic and end-systolic volumes over time (beta = 14.3 , r = 0.40, P = .001 and beta = 11.3, r = 0.44, P < .001, respectively), whereas intermediate and late hypoenhancement had comparable predictive values of change in LV ejection fraction (beta = -3.1, r = -0.29, P = .02 and beta = -2.8, r = -0.27, P = .04, respectively). CNR corrected for spatial resolution was significantly superior for late enhancement compared with the other sequences (P < .001).Conclusion: By using cardiac MR imaging, late hypoenhancement is the best prognostic marker of LV remodeling, with highest CNR between the infarcted myocardium and MVO regions. (C) RSNA, 2008