Choi K M, Kim R J, Gubernikoff G, Vargas J D, Parker M, Judd R M
Feinberg Cardiovascular Research Institute, Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Circulation. 2001 Sep 4;104(10):1101-7. doi: 10.1161/hc3501.096798.
Previous animal studies have demonstrated that the transmural extent of acute myocardial infarction defined by contrast-enhanced MRI (ceMRI) relates to early restoration of flow and future improvements in contractile function. We tested the hypothesis that ceMRI would have similar predictive value in humans.
Twenty-four patients who presented with their first myocardial infarction and were successfully revascularized underwent cine and ceMRI of their heart within 7 days (scan 1) of the peak MB band of creatine kinase. Cine MRI was repeated 8 to 12 weeks later (scan 2). The transmural extent of infarction on scan 1 and wall thickening on both scans were determined using a 72-segment model. A total of 524 of 1571 segments (33%) were dysfunctional on scan 1. Improvement in segmental contractile function on scan 2 was inversely related to the transmural extent of infarction on scan 1 (P=0.001). Improvement in global contractile function, as assessed by ejection fraction and mean wall thickening score, was not predicted by peak creatine kinase-MB (P=0.66) or by total infarct size, as defined by MRI (P=0.70). The best predictor of global improvement was the extent of dysfunctional myocardium that was not infarcted or had infarction comprising <25% of left ventricular wall thickness (P<0.005 for ejection fraction, P<0.001 for mean wall thickening score).
In patients with acute myocardial infarction, the transmural extent of infarction defined by ceMRI predicts improvement in contractile function.
既往动物研究表明，对比增强磁共振成像（ceMRI）所定义的急性心肌梗死透壁范围与血流的早期恢复及未来收缩功能的改善相关。我们检验了ceMRI在人类中具有类似预测价值的假说。
24例首次发生心肌梗死且成功进行血运重建的患者在肌酸激酶MB峰值出现后的7天内（扫描1）接受了心脏电影磁共振成像和ceMRI检查。8至12周后重复进行电影磁共振成像检查（扫描2）。使用72节段模型确定扫描1时梗死的透壁范围以及两次扫描时的室壁增厚情况。在扫描1时，1571个节段中有524个（33%）功能异常。扫描2时节段收缩功能的改善与扫描1时梗死的透壁范围呈负相关（P=0.001）。通过射血分数和平均室壁增厚评分评估的整体收缩功能改善情况，不能由肌酸激酶MB峰值（P=0.66）或MRI所定义的总梗死面积预测（P=0.70）。整体改善的最佳预测指标是未梗死或梗死范围占左心室壁厚度小于25%的功能异常心肌范围（射血分数P<0.005，平均室壁增厚评分P<0.001）。
在急性心肌梗死患者中，ceMRI所定义的梗死透壁范围可预测收缩功能的改善情况。
