Beek Aernout M, Kühl Harald P, Bondarenko Olga, Twisk Jos W R, Hofman Mark B M, van Dockum Willem G, Visser Cees A, van Rossum Albert C
Department of Cardiology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
J Am Coll Cardiol. 2003 Sep 3;42(5):895-901. doi: 10.1016/s0735-1097(03)00835-0.
We evaluated whether delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) using an extracellular contrast agent could predict improvement of dysfunctional but viable myocardium after acute reperfused myocardial infarction (MI).
The transmural extent of hyperenhancement at DCE-MRI has been related to improvement of function in reperfused MI. However, evidence is still limited, and earlier reports have produced conflicting results regarding the significance of contrast patterns after infarction.
Thirty patients (mean age 59 +/- 11 years, 27 males) underwent cine MRI and DCE-MRI 7 +/- 3 days after a first reperfused acute MI and follow-up cine MRI at 13 +/- 3 weeks. Segmental wall thickening and segmental extent of hyperenhancement were scored in 1,689 segments.
Of 500 dysfunctional segments, 273 (55%) improved at follow-up. There was no difference in likelihood of improvement or complete functional recovery between segments with 0% and 1% to 25% hyperenhancement. The likelihood of improvement of segments without hyperenhancement was 2.9, 14.3, and 20 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001). The likelihood of complete functional recovery of segments without hyperenhancement was 3.8, 11.1, and 50 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001).
In patients with recent reperfused MI, functional improvement of stunned myocardium is predicted by DCE-MRI.
我们评估了使用细胞外造影剂的延迟对比增强磁共振成像（DCE-MRI）能否预测急性再灌注心肌梗死后功能失调但仍存活的心肌的改善情况。
DCE-MRI上心肌强化的透壁范围与再灌注心肌梗死的功能改善有关。然而，证据仍然有限，早期报告对于梗死后对比模式的意义产生了相互矛盾的结果。
30例患者（平均年龄59±11岁，27例男性）在首次再灌注急性心肌梗死后7±3天接受了电影MRI和DCE-MRI检查，并在13±3周时接受了随访电影MRI检查。对1689个节段进行节段性室壁增厚和强化节段范围评分。
在500个功能失调节段中，273个（55%）在随访时有所改善。强化为0%和1%至25%的节段在改善或完全功能恢复的可能性上没有差异。无强化节段改善的可能性分别比强化为26%至50%、51%至75%和>75%的节段高2.9倍、14.3倍和20倍（p<0.001）。无强化节段完全功能恢复的可能性分别比强化为26%至50%、51%至75%和>75%的节段高3.8倍、11.1倍和50倍（p<0.001）。
在近期再灌注心肌梗死患者中，DCE-MRI可预测顿抑心肌的功能改善情况。
