Imaging techniques - Cardiovascular MRI for detection of myocardial viability and ischaemia
Imaging techniques - Cardiovascular MRI for detection of myocardial viability and ischaemia
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DOI：
10.1136/hrt.2005.071290
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发表时间：
2007-01-01
期刊：
影响因子：
5.7
通讯作者：
Sechtem, Udo
中科院分区：
文献类型：
--
作者：
Mahrholdt, Heiko;Klem, Igor;Sechtem, Udo
在美国和欧洲，冠状动脉疾病(CAD)仍然是主要的死亡原因。尽管整个西方世界死于心肌梗死的人数有所下降，但充血性心力衰竭的死亡率增加了一倍多。重要的是，冠心病占充血性心力衰竭病例的大部分(近70%)。在冠心病所致充血性心力衰竭患者的临床治疗中，对心肌存活性的准确评估对指导治疗至关重要；这是因为对功能障碍但存活的心肌进行血运重建可以改善心功能和长期存活率。另一种日常临床情景是对怀疑患有冠心病的患者进行风险分层，这些患者因工作而出现胸痛综合征。如果左心功能正常，负荷试验仍然是检测心肌缺血的主要方法。传统上，核素显像、负荷超声心动图和负荷心电图一直是临床上评估心肌存活和检测心肌缺血的主要手段。然而，心血管磁共振(CMR)是一种迅速崛起的非侵入性成像技术，可以在任何需要的平面上无辐射地提供高分辨率的心脏图像。CMR不是单一的技术，而是由几种技术组成，这些技术可以在患者检查期间单独执行或以各种组合执行。例如，Cine-CMR可以评估心脏的形态、功能和收缩储备；使用血管扩张剂和不使用血管扩张剂的灌注CMR可以评估心肌灌注储备；对比增强CMR(CeCMR)可以用于梗塞检测和非侵入性组织定征。本文将通过讨论不同的评估心肌存活和心肌缺血的CMR技术，回顾CMR在治疗已知或可疑CAD患者方面的潜力。
Coronary artery disease (CAD) remains the leading cause of death in the United States and Europe. Although there has been a decline in the number of deaths from myocardial infarction throughout the western world, the mortality for congestive heart failure has more than doubled. Importantly, CAD accounts for the majority (almost 70%) of congestive heart failure cases. In the clinical management of patients with congestive heart failure caused by CAD, the accurate assessment of myocardial viability is crucial to guide treatment; this is because revascularisation of dysfunctional but viable myocardium can improve ventricular function and long-term survival. Another everyday clinical scenario is the risk stratification of patients suspected to have CAD presenting for work up of chest pain syndromes. If left ventricular function is normal, stress testing remains the primary approach for detecting myocardial ischaemia. Traditionally nuclear imaging, stress echocardiography and (stress) electrocardiography have been the clinical mainstays for assessing myocardial viability as well as to detect myocardial ischaemia. However, cardiovascular MR (CMR) is a rapidly emerging non-invasive imaging technique, providing high-resolution images of the heart in any desired plane and without radiation. Rather than a single technique, CMR consists of several techniques that can be performed separately or in various combinations during a patient examination. For example, cine-CMR can provide assessment of cardiac morphology, function and contractile reserve; perfusion CMR with and without vasodilators can provide assessment of myocardial perfusion reserve, and contrast enhanced CMR (ceCMR) can be used for infarct detection as well as non-invasive tissue characterisation. This article will review the potential of CMR for managing patients with known or suspected CAD by discussing different CMR techniques for assessment of myocardial viability and myocardial ischaemia.