Late gadolinium-enhanced cardiovascular magnetic resonance evaluation of infarct size and microvascular obstruction in optimally treated patients after acute myocardial infarction
Late gadolinium-enhanced cardiovascular magnetic resonance evaluation of infarct size and microvascular obstruction in optimally treated patients after acute myocardial infarction
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DOI：
10.1080/10976640701545008
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发表时间：
2007-01-01
影响因子：
6.4
通讯作者：
van Rossum, Albert C.
中科院分区：
文献类型：
--
作者：
Nijveldt, Robin;Beek, Aernout M.;van Rossum, Albert C.
目的：心血管磁共振（CMR）被认为是临床试验中监测急性心肌梗死（AMI）患者的标准成像模式。然而，有限的数据是关于梗死面积，存在和微血管损伤（MVO）的程度，并随着时间的推移，在这些最佳治疗的患者的心脏功能的变化。在这项研究中，我们前瞻性地研究了AMI后一个统一的、最佳治疗的患者组中梗死面积随时间的变化，以及MVO的发生率和意义。方法：40例患者在初次支架植入术后9天内和4个月接受电影和晚期钆增强CMR。计算左室射血分数（LVEF）、心肌梗死面积（IS）和MVO面积。结果：随访时IS下降19.0%（P < 0.01）。23例（57.5%）MVO患者随访时梗死面积较大，左室容积较大，LVEF较低，IS复旧较多。总体而言，LVEF从42.3 +/- 9.8%改善至44.0 +/- 9.8%（p = 0.06），与MVO的存在或大小无关。结论：在AMI后接受最佳治疗的患者中，冠状动脉尺寸随时间减少19.0%。尽管有最佳的再灌注，MVO被发现在大多数患者。尽管MVO患者的梗死面积更大，左心室重构指数更差，但随访时的功能变化与无MVO患者相当。
Purpose: Cardiovascular magnetic resonance (CMR) is considered the standard imaging modality in clinical trials to monitor patients after acute myocardial infarction (AMI). However, limited data is available with respect to infarct size, presence, and extent of microvascular injury (MVO), and changes over time, in relation to cardiac function in these optimally treated patients. In this study, we prospectively investigate the change of infarct size over time, and the incidence and significance of MVO in a uniform, optimally treated patient group after AMI. Methods: Forty patients underwent cine and late gadolinium-enhanced CMR within 9 days and at 4 months after primary stenting. Left ventricular ejection fraction (LVEF), infarct size (IS) and MVO size were calculated. Results: IS decreased with 19.0% at follow-up (p < 0.01). The 23 (57.5%) patients with MVO had larger infarct size, higher left ventricular volumes and lower LVEF and more involution of IS at follow-up. Overall, LVEF improved from 42.3 +/- 9.8% to 44.0 +/- 9.8% (p = 0.06), irrespective of presence or size of MVO. Conclusion: Infarct size reduces over time by 19.0% in optimally treated patients after AMI. Despite optimal reperfusion, MVO was found in the majority of patients. Although patients with MVO had larger infarcts and worse indices of left ventricular remodelling, functional change at follow-up was comparable to patients without MVO.