Magnetic resonance imaging delineates the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction.
Magnetic resonance imaging delineates the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction.
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DOI：
10.1161/circimaging.109.900761
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Arai AE
中科院分区：
文献类型：
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作者：
Berry C;Kellman P;Mancini C;Chen MY;Bandettini WP;Lowrey T;Hsu LY;Aletras AH;Arai AE
危险区（AAR）是心肌梗死（MI）大小的关键决定因素。我们研究了急性心肌梗死患者AAR的MRI测量是否与血管造影AAR风险评分相关。使用亮血T2-稳态自由旋进MRI（T2-SSFP MRI）描述50例连续急性MI患者的AAR，同时在钆晚期对比增强图像上测量梗死面积。AAR还使用APPROACH和杜克血管造影危险评分和ST段抬高评分进行估计。心肌挽救率为AAR减去梗死面积。除非另有说明，否则结果为平均值±SD。患者年龄为61±12岁; 76%患有ST段抬高型MI; 20%患有既往MI。所有患者均在初次就诊后4±2天接受MRI检查。MRI和APPROACH血管造影估计的AAR之间的关系相似（总体尺寸相对于LV质量（分别为32±12%和30±12%，p=0.33）），相关性良好（r=0.78; p<0.0001），Bland Altman分析中偏倚为2.5%。杜克Jeopardy评分低估了相对于梗死面积的AAR，与MRI相关性较差（r=0.39; p=0.0055）。ST段抬高评分低估了19例（50%）受试者的梗死面积，与MRI无相关性（r=0.27; p=0.06）。心肌挽救根据血管造影/PCI结束时的TIMI血流分级而变化（p=0.04），TIMI血流分级是心肌挽救的单变量预测因子（p=0.011）。在多变量分析中，T2-SSFP MRI预测梗死面积（p<0.0001）。T2-SSFP MRI描绘了AAR，并在结合梗死面积测量时能够估计心肌挽救。
The area-at-risk (AAR) is a key determinant of myocardial infarction (MI) size. We investigated whether MRI measurement of AAR would correlate with an angiographic AAR risk score in patients with acute MI. Bright blood T2-prepared steady-state free-precession MRI (T2-SSFP MRI) was used to depict the AAR in 50 consecutive acute MI patients while infarct size was measured on gadolinium late contrast enhancement images. AAR was also estimated using the APPROACH and DUKE angiographic jeopardy scores and ST elevation score. Myocardial salvage was AAR minus infarct size. Results are mean±SD unless specified. Patients were of 61±12 years of age; 76% had ST elevation MI; 20% had prior MI. All underwent MRI 4±2 days following initial presentation. The relationship between MRI and the APPROACH angiographic estimates of AAR were similar (overall size relative to LV mass (32±12% vs. 30±12% respectively, p=0.33)), correlated well (r=0.78; p<0.0001) and had 2.5% bias in Bland Altman analysis. The DUKE Jeopardy Score underestimated AAR relative to infarct size and correlated less well with MRI (r=0.39; p=0.0055). ST elevation score underestimated infarct size in 19(50%) subjects and did not correlate with MRI (r=0.27; p=0.06). Myocardial salvage varied according to TIMI flow grade at the end of angiography/PCI (p=0.04) and TIMI flow grade was a univariable predictor of myocardial salvage (p=0.011). In multivariable analyses, infarct size was predicted by T2-SSFP MRI (p<0.0001). T2-SSFP MRI delineates the AAR and enables estimation of myocardial salvage when coupled with a measurement of infarct size.