MRI Evaluation Of Acute Cardiovascular Disease

对于目前的诊断策略，在急诊科管理胸痛仍然是一个挑战。我们假设，MRI对心功能、血流灌注和生存能力的评估可以准确地对潜在的急性冠脉综合征患者进行分诊。在这项对161名连续患者进行的前瞻性研究中，入选需要30分钟的胸痛与心肌缺血相容，但心电图不能诊断为急性心肌梗死。在静息状态下进行MRI检查，包括血流灌注、左心功能和Gd增强的心肌梗死检测。对MRI进行了定性解释，也进行了定量分析。MRI诊断急性冠脉综合征的敏感性和特异性分别为84%和85%，心电图分别为80%和61%，初始肌钙蛋白I分别为20%和97%。MRI诊断急性非ST段抬高心肌梗死的敏感性和特异性分别为100%和81%，而心电图分别为70%和57%，初始肌钙蛋白I分别为50%和97%。受试者操作特征分析和多因素Logistic回归分析显示，MRI异常是预测急性冠脉综合征的最强指标，且对包括心电图、初始肌钙蛋白I和TIMI风险评分在内的临床参数具有独立的诊断价值。静息MRI扫描表现出诊断性操作特征，适用于急诊科胸痛患者的分诊。在对胸痛的紧急评估中，MRI准确地检测到了包括肌钙蛋白I阴性的高比例急性冠脉综合征患者

Managing chest pain in the emergency department remains a challenge with current diagnostic strategies. We hypothesized that MRI assessment of cardiac function, perfusion, and viability could accurately triage patients with potential acute coronary syndrome. In this prospective study of 161 consecutive patients, enrollment required 30 minutes of chest pain compatible with myocardial ischemia but an ECG not diagnostic of acute myocardial infarction. MRI was performed at rest and included perfusion, left ventricular function, and gadolinium-enhanced myocardial infarction detection. MRI was interpreted qualitatively but also analyzed quantitatively. The sensitivity and specificity for detecting acute coronary syndrome was 84% and 85% by MRI, 80% and 61% by ECG, and 20% and 97% for initial troponin-I. For detection of the subset of patients with acute non-ST elevation myocardial infarction, the sensitivity and specificity of MRI was 100% and 81% compared with 70% and 57% for ECG, and 50% and 97% for initial troponin-I. Receiver operator characteristic analysis and multivariate logistic regression analysis showed an abnormal MRI was the strongest predictor of acute coronary syndrome and had independent diagnostic value over clinical parameters including ECG, initial troponin-I, and the TIMI risk score. The resting MRI scan exhibited diagnostic operating characteristics suitable for triage of patients with chest pain in the emergency department. Performed urgently in the evaluation of chest pain, MRI accurately detected a high fraction of patients with acute coronary syndrome including patients that were troponin-I negative