REGIONAL HETEROGENEITY OF HUMAN MYOCARDIAL INFARCTS DEMONSTRATED BY CONTRAST-ENHANCED MRT POTENTIAL MECHANISMS
REGIONAL HETEROGENEITY OF HUMAN MYOCARDIAL INFARCTS DEMONSTRATED BY CONTRAST-ENHANCED MRT POTENTIAL MECHANISMS
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DOI：
10.1161/01.cir.92.5.1117
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发表时间：
1995-09-01
期刊：
影响因子：
37.8
通讯作者：
ZERHOUNI, EA
中科院分区：
文献类型：
--
作者：
LIMA, JAC;JUDD, RM;ZERHOUNI, EA
研究背景心肌再灌注是影响急性心肌梗死患者预后的关键因素。在这些患者中，冠状动脉血流通常通过血管造影术评估，组织灌注通过示踪剂血管造影术评估。本研究的目的是探讨磁共振成像（MRI）是否提供信息，心肌灌注和损害超出了血管造影和铊造影急性心肌infarct.Methods和结果22例近期心肌梗死患者的心电图，超声心动图，冠状动脉造影，快速对比增强MRI。12例患者还进行了运动铊造影。梗死区和非梗死区的时间-强度曲线与冠状动脉解剖和左室功能相关。通过与正常心肌模式的比较，在梗塞区域观察到两种灌注模式。除1例患者外，所有患者在造影后10分钟内梗死区均出现持续性心肌增强。在10例患者中，这一高增强区域围绕着梗死区域中心的一个信号降低的内膜下区域，与血管造影显示的冠状动脉闭塞、ECG显示的Q波和超声心动图显示的更大区域功能障碍相关。此外，MRI异常的范围和位置相关以及固定的单光子发射计算机断层扫描铊defects.Conclusions的范围和位置的大的人类梗死，与长期阻塞的梗死相关的动脉，其特点是中央暗区周围的hyperenhanced地区的MRI。相反，再灌注梗死与较少的区域功能障碍有统一的信号增强。急性心肌梗死患者的MRI高增强段与固定的心肌造影缺损相关性良好。
Background Myocardial reperfusion is pivotal to the prognosis of patients with acute myocardial infarction. In these patients, coronary flow is generally assessed by angiography and tissue perfusion by tracer scintigraphy. This study was designed to examine whether magnetic resonance imaging (MRI) provides information on myocardial perfusion and damage beyond that supplied by angiography and thallium scintigraphy after acute myocardial infarction.Methods and Results Twenty-two patients with recent myocardial infarction had ECG, echocardiography, coronary angiography, and fast contrast-enhanced MRI. Twelve patients also had exercise thallium scintigraphy. Time-intensity curves obtained from infarcted and noninfarcted regions were correlated with coronary anatomy and left ventricular function. Two perfusion patterns were observed in infarcted regions by comparison with the normal myocardial pattern. All patients but 1 had persistent myocardial hyperenhancement within the infarcted re ion up to 10 minutes after contrast. In 10 patients, this hyperenhanced region surrounded a subendocardial area of decreased signal at the center of the infarcted region associated with coronary occlusion at angiography, Q waves on ECG, and greater regional dysfunction by echocardiography. Moreover, the extent and location of the MRI abnormalities correlated well with the extent and location of the fixed single-photon emission computed tomography thallium defects.Conclusions Large human infarcts, associated with prolonged obstruction of the infarct-related artery, are characterized by central dark zones surrounded by hyperenhanced regions on MRI. Conversely, reperfused infarcts with less regional dysfunction have uniform signal hyperenhancement. The MRI hyperenhanced segment correlates well with the fixed scintigraphic defect in patients with acute myocardial infarction.