Coronary high-intensity plaque on T1-weighted magnetic resonance imaging and its association with myocardial injury after percutaneous coronary intervention
Coronary high-intensity plaque on T1-weighted magnetic resonance imaging and its association with myocardial injury after percutaneous coronary intervention
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DOI：
10.1093/eurheartj/ehv187
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发表时间：
2015-08-01
影响因子：
39.3
通讯作者：
Aonuma, Kazutaka
中科院分区：
文献类型：
--
作者：
Hoshi, Tomoya;Sato, Akira;Aonuma, Kazutaka
非增强T1加权成像（T1 WI）是一种新的无创性冠状动脉易损斑块成像技术，可显示高强度斑块（HIP）。然而，HIP和经皮冠状动脉介入治疗（PCI）之间的关系尚未得到评估。我们研究了HIP的存在和PCI后心肌损伤的发病率之间的关联。方法和结果A共77例稳定型心绞痛患者进行了成像与非对比T1 WI通过使用1.5 T磁共振系统（HIP和非HIP组，N = 31和46例，分别）。我们将HIP定义为冠状动脉斑块与心肌信号强度比（PMR）>= 1.4。分别于术前及术后24 h测定高敏心肌肌钙蛋白T（hs-cTnT）。经皮冠状动脉介入治疗相关心肌损伤（PMI）定义为hs-cTnT升高>5 x第99百分位数参考上限。高强度斑块与血管内超声的超声衰减和阳性重塑特征相关。尽管两组之间的基线hs-cTnT相似，但HIP组的hs-cTnT升高显著高于非HIP组（0.065 [0.023-0.304] vs. 0.017 [0.005-0.026]，P < 0.001）。经皮冠状动脉介入治疗相关心肌损伤发生率HIP组高于非HIP组（58.1vs.10.9%，P < 0.001），PMR预测PMI的临界值为1.44（敏感性78.3%，特异性81.5%）。多因素分析显示，PMR ≥ 1.4是PMI的显著预测因子（OR 5.63，95%可信区间1.28-24.7，P = 0.022）。
Aims Non-contrast T-1-weighted imaging (T1WI) has emerged as a novel non-invasive imaging for vulnerable coronary plaque showing a high-intensity plaque (HIP). However, the association between HIP and percutaneous coronary intervention (PCI) has not been evaluated. We investigated the association between the presence of HIP and the incidence of myocardial injury after PCI.Methods and results A total of 77 patients with stable angina were imaged with non-contrast T1WI by using a 1.5 T magnetic resonance system (HIP and non-HIP group, N = 31 and 46 patients, respectively). We defined HIP as a coronary plaque to myocardium signal intensity ratio (PMR) of >= 1.4. High-sensitive cardiac troponin-T (hs-cTnT) was measured at baseline and 24 h after PCI. Percutaneous coronary intervention-related myocardial injury (PMI) was defined as an elevation of hs-cTnT >5 x 99th percentile upper reference limit. High-intensity plaque was associated with the characteristics of ultrasound attenuation and positive remodelling on intravascular ultrasound. Although baseline hs-cTnT was similar between the groups, increase in hs-cTnT was significantly greater in the HIP vs. non-HIP group (0.065 [0.023-0.304] vs. 0.017 [0.005-0.026], P < 0.001). Percutaneous coronary intervention-related myocardial injury occurred more frequently in the HIP than non-HIP group (58.1 vs. 10.9%, P < 0.001), and the cut-off value of PMR found to be 1.44 for predicting PMI (sensitivity 78.3% and specificity 81.5%). In multivariate analysis, a PMR of >= 1.4 was a significant predictor of PMI (odds ratio 5.63, 95% confidence interval 1.28-24.7, P = 0.022).Conclusion High-intensity plaque on non-contrast T1WI was characterized as vulnerable coronary plaque on IVUS and was associated with higher incidence of PMI.