MRI Evaluation Of Acute Cardiovascular Disease

在急诊室管理胸痛仍然是当前诊断策略的挑战。我们假设MRI评估心脏功能、灌注和存活性可以准确地对潜在急性冠脉综合征患者进行分类。在这项包含161名连续患者的前瞻性研究中，入组要求胸痛持续30分钟，与心肌缺血一致，但ECG不能诊断为急性心肌梗死。在静息状态下进行MRI，包括灌注、左心室功能和钆增强心肌梗死检测。MRI定性解释，但也定量分析。MRI检测急性冠脉综合征的敏感性和特异性分别为84%和85%，ECG为80%和61%，初始肌钙蛋白I为20%和97%。对于急性非ST段抬高心肌梗死患者的检测，MRI的敏感性和特异性分别为100%和81%，ECG为70%和57%，初始肌钙蛋白I为50%和97%。受试者操作特征分析和多变量logistic回归分析显示，MRI异常是急性冠状动脉综合征最强的预测因子，与临床参数（包括ECG、初始肌钙蛋白I和TIMI风险评分）相比具有独立的诊断价值。静息MRI扫描显示出适合急诊科胸痛患者分诊的诊断操作特征。在胸痛的评估中，MRI可以准确地检测到高比例的急性冠状动脉综合征患者，包括肌钙蛋白I阴性的患者

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