Validation of black blood late gadolinium enhancement (LGE) for evaluation of myocardial infarction in patients with or without pathological Q-wave on electrocardiogram (ECG)
Validation of black blood late gadolinium enhancement (LGE) for evaluation of myocardial infarction in patients with or without pathological Q-wave on electrocardiogram (ECG)
复制标题
黑血晚期钆增强 (LGE) 用于评估心电图 (ECG) 上有或没有病理性 Q 波的患者心肌梗死的验证
DOI：
10.21037/cdt.2019.12.11
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发表时间：
2020-04-01
影响因子：
2.4
通讯作者：
He, Liping
中科院分区：
文献类型：
--
作者：
Song, Linsheng;Ma, Xiaohai;He, Liping
背景资料：病理性Q波（QW）是梗死心肌体积的重要指标，与非Q波（NQW）梗死相比，表明预后较差。传统的分类方法根据QW和NQW将梗死分为透壁性和非透壁性。这种观点受到了晚期钆增强（LGE）MR成像的挑战。常规LGE（Conv-LGE）检测内膜下MI受限于亮血池。暗血LGE成像（DB-LGE）使血池为零，提高了检测内膜下梗死的显著性和准确性。我们假设，改善检测的subendocardium增强与DB-LGE将导致改善相关性的心电图（ECG）和程度infarct.Methods：64例临床确诊的梗死患者参加了这项前瞻性研究。所有受试者均接受心脏MR成像，包括conv-LGE和DB-LGE。同日进行双导联心电图检查。由一位有经验的心脏病专家将患者分为QW和NQW组。MI定量采用MI%（MI体积与整个心肌体积的比值）和透壁分级，分别采用配对t检验和Wilcoxon检验进行比较。根据信号强度比（SIR）和对比度噪声比（CNR）评价Conv-LGE和DB-LGE获得的图像质量。结果：最终分析入组了五十六例受试者[ 23例（41%）QW和33例（59%）NQW梗死]。对于QW队列，两个序列均将21/23例（91%）受试者的梗死分类为透壁性，2/23例（9%）为内膜下性。对于NQW队列，两个序列均将16/33例（48%）受试者的梗死分类为透壁性，17/33例（52%）为内膜下性。BB-LGE在QW和NQW队列中检测内膜下梗死的差异有统计学意义（Z=-5.85，P
Background: The pathological Q-wave (QW) is an important indicator of infarcted myocardial volume indicating a worse prognosis compared to non-Q-wave (NQW) infarctions. Traditional classification divides infarcts into transmural and non-transmural based on QW and NQW. This view has been challenged by the advent of late gadolinium enhancement (LGE) MR imaging. Conventional LGE (Conv-LGE) detection of subendocardial MI is limited by bright blood pool. Dark Blood LGE imaging (DB-LGE) nulls the blood pool improving the conspicuity and accuracy of detection of subendocardial infarcts. We hypothesize that improved detection of subendocardial enhancement with DB-LGE will result in improved correlation of electrocardiogram (ECG) and extent of infarction.Methods: Sixty-four clinically confirmed infarction patients were enrolled in this prospective study. All the participants underwent cardiac MR imaging including conv-LGE and DB-LGE. Twelve-lead ECG were performed on the same day. The patients were divided into QW and NQW groups by one experienced cardiologist. MI quantitation was by MI% (the ratio of MI volume to whole myocardial volume) and transmural grading, compared using paired t-test and Wilcoxon-test, respectively. The image quality obtained by Conv-LGE and DB-LGE were evaluated according to the signal intensity ratio (SIR) and contrast-to-noise ratio (CNR).Results: Fifty-six subjects were enrolled in the final analysis [ 23 (41%) QW and 33 (59%) NQW infarcts]. For the QW cohort, both sequences classified infarcts as transmural in 21/23 (91%) subjects and subendocardial in 2/23 (9%). For the NQW cohort, both sequences classified infarcts as transmural in 16/33 (48%) subjects and subendocardial in 17/33 (52%). Using BB-LGE there were significant differences in detecting subendocardial infarcts in QW and NQW cohorts (Z=-5.85, P