Prognostic Value of Myocardial Infarct Size and Contractile Reserve Using Magnetic Resonance Imaging
Prognostic Value of Myocardial Infarct Size and Contractile Reserve Using Magnetic Resonance Imaging
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DOI：
10.1016/j.jacc.2009.07.027
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发表时间：
2009-11-03
影响因子：
24
通讯作者：
Nagel, Eike
中科院分区：
文献类型：
--
作者：
Kelle, Sebastian;Roes, Stijntje D.;Nagel, Eike
目的 我们的目的是评估晚期钆增强 (LGE) 磁共振成像 (MRI) 评估的心肌梗死面积相对于低剂量多巴酚丁胺磁共振 (DSMR) 收缩储备对长期无事件生存的预测价值。 177 名患有 LGE MRI 已知冠状动脉疾病和疤痕组织的患者被纳入研究。评估静息时和低剂量 DSMR 期间的左心室 (LV) 功能参数，并计算室壁运动评分指数。结果 11 名患者 (6.2%) 在随访期间（平均 20.3 个月）发生事件。与静息时和低剂量 DSMR 期间的 LV 射血分数和 LV 体积相比，梗死面积是事件的更强预测因子。心肌梗塞大小用于将死亡高风险患者（空间范围> = 6节段，n = 98）与低风险患者（空间范围< 6节段，n = 79）分开。在高危患者亚组中，梗塞的透壁性并不是事件的预测因子。然而，与室壁运动评分指数无变化（6.7%；n = 15；p = 0.008）相比，收缩储备的存在（n = 63）与显着更高的事件数量（12.7%）相关。 结论 对于接受药物治疗的心肌梗死患者，LGE MRI 上的心肌梗死面积比收缩储备更能预测临床结果。在有大面积心肌疤痕的患者中，收缩储备的存在对于事件的预测比疤痕组织更重要。 (J Am Coll Cardiol 2009;54:1770-7) (c) 2009 年，美国心脏病学会基金会
Objectives Our aim was to assess the predictive value of myocardial infarct size assessed with late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in medically treated patients with chronic myocardial infarction relative to contractile reserve on low-dose dobutamine magnetic resonance (DSMR) for long-term event-free survival.Background Information on the relative merits of scar tissue and contractile reserve to predict long-term prognosis in patients with chronic myocardial infarction is lacking.Methods A total of 177 patients with known coronary artery disease and scar tissue on LGE MRI were enrolled. Left ventricular (LV) functional parameters at rest and during low-dose DSMR were assessed, and the wall motion score index was calculated.Results Eleven patients (6.2%) suffered an event during follow-up (average 20.3 months). Infarct size was a stronger predictor of events than LV ejection fraction and LV volumes at rest and during low-dose DSMR. Myocardial infarct size was used to separate patients at high risk (spatial extent >= 6 segments, n = 98) from those at low risk (spatial extent < 6 segments, n = 79) for mortality. In the subgroup of patients at high risk, transmurality of infarct was not a predictor of events. However, the presence of contractile reserve (n = 63) was associated with a significantly higher number of events (12.7%) compared with no change in wall motion score index (6.7%; n = 15; p = 0.008).Conclusions Myocardial infarct size on LGE MRI is a stronger predictor of clinical outcome than contractile reserve in medically treated patients with myocardial infarction. In patients with large myocardial scar, the presence of contractile reserve is more important for the prediction of events than scar tissue. (J Am Coll Cardiol 2009;54:1770-7) (c) 2009 by the American College of Cardiology Foundation