Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance
Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance
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DOI：
10.1161/01.cir.0000078641.19365.4c
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发表时间：
2003-07-08
期刊：
影响因子：
37.8
通讯作者：
Pennell, DJ
中科院分区：
文献类型：
--
作者：
McCrohon, A;Moon, JCC;Pennell, DJ
背景-心力衰竭的治疗部分取决于疾病的根本原因。我们评价了心血管磁共振(CMR)在鉴别扩张型心肌病(DCM)和冠心病(CAD)所致的左心功能不全(LV)方面的作用。方法和结果：对90例心力衰竭和LV收缩功能不全的患者(63例DCM合并冠状动脉通畅和27例冠状动脉造影有意义的患者)进行了晚期Gd增强扫描。我们还研究了15名没有冠状动脉危险因素和/或冠状动脉畅通的对照受试者。对照组中无一例(0%)心肌Gd增强，但所有左心功能不全和冠心病患者(100%)均有心肌Gd增强，表现为心内膜下或跨室壁。扩张型心肌病有3种表现：无强化(59%)，心肌强化与冠心病(13%)不能区分，中壁强化呈片状或纵纹状明显不同于冠心病者(28%)。结论Gd-CMR是鉴别DCM与与CAD相关的左心功能不全的有效方法，为DCM的诊断提供了新的思路。这些数据表明，在13%的患者中，使用冠脉造影术作为判断冠心病是否存在左心功能不全的标准可能会导致13%的患者错误地确定DCM的原因，这可能是因为梗死后的冠状动脉再通。扩张型心肌病患者的中壁心肌强化类似于尸检中发现的纤维化；以前没有活体显示，值得进一步研究。在扩张型心肌病的诊断工作中，CMR可能成为常规冠状动脉造影术的有用替代方法。
Background-Heart failure treatment depends partly on the underlying cause of the disease. We evaluated cardiovascular magnetic resonance (CMR) for the problem of differentiating dilated cardiomyopathy (DCM) from left ventricular (LV) dysfunction caused by coronary artery disease (CAD).Methods and Results-Late gadolinium enhancement with CMR was performed in 90 patients with heart failure and LV systolic dysfunction (63 patients with DCM and unobstructed coronary arteries and 27 with significant CAD at angiography). We also studied 15 control subjects with no coronary risk factors and/or unobstructed coronary arteries. None (0%) of the control subjects had myocardial gadolinium enhancement; however, all patients (100%) with LV dysfunction and CAD had enhancement, which was subendocardial or transmural. In patients with DCM, there were 3 findings: no enhancement (59%); myocardial enhancement indistinguishable from the patients with CAD (13%); and patchy or longitudinal striae of midwall enhancement clearly different from the distribution in patients with CAD (28%).Conclusions-Gadolinium CMR is a powerful technique to distinguish DCM from LV dysfunction related to CAD and yields new insights in DCM. These data suggest that using the coronary angiogram as the arbiter for the presence of LV dysfunction caused by CAD could have lead to an incorrect assignment of DCM cause in 13% of patients, possibly because of coronary recanalization after infarction. The midwall myocardial enhancement in patients with DCM is similar to the fibrosis found at autopsy; it has not previously been visualized in vivo and warrants further investigation. CMR may become a useful alternative to routine coronary angiography in the diagnostic workup of DCM.