肥厚型梗阻性心肌病经皮腔内室间隔心肌消融术后心肌梗死：对比增强磁共振成像评估
Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging.
作者信息
van Dockum Willem G, ten Cate Folkert J, ten Berg Jurrien M, Beek Aernout M, Twisk Jos W R, Vos Jeroen, Hofman Mark B M, Visser Cees A, van Rossum Albert C
机构信息
Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
出版信息
J Am Coll Cardiol. 2004 Jan 7;43(1):27-34. doi: 10.1016/j.jacc.2003.08.031.
OBJECTIVES
The aim of this study was to evaluate myocardial infarction induced by percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy using contrast-enhanced (CE) magnetic resonance imaging (MRI).
BACKGROUND
Contrast-enhanced MRI delineates the extent of myocardial infarction in coronary artery disease, but its role in ethanol-induced infarction has not been established.
METHODS
Cine and CE MRI were performed before and one month after PTSMA in 24 patients. Size and location of the induced infarction were related to left ventricular (LV) mass reduction, enzyme release, volume of ethanol administered, LV outflow tract gradient reduction, and coronary ablation site.
RESULTS
One month after PTSMA, regional hyperenhancement was visualized in the basal interventricular septum in all patients. Mean infarction size was 20 +/- 9 g, corresponding to 10 +/- 5% and 31 +/- 16% of total LV and septal mass, respectively. Total LV mass decreased from 219 +/- 64 to 205 +/- 64 g (p < 0.01), and septal mass from 76 +/- 25 to 68 +/- 22 g (p < 0.01). Total LV mass reduction exceeded septal mass reduction (p < 0.01). Infarction size correlated with peak creatine phosphokinase-MB (beta = 0.67, p < 0.01), volume of ethanol administered (beta = 0.47, p = 0.02), total LV and septal mass reduction (beta = 0.50, p = 0.02; beta = 0.73, p < 0.01), and gradient reduction (beta = 0.63, p < 0.01). Seven patients with exclusively right-sided septal infarction had smaller infarction size and less gradient reduction than remaining patients with left-sided or transmural infarction (p < 0.01). In five of these, PTSMA was performed distal in the target artery.
CONCLUSIONS
Contrast-enhanced MRI allowed detailed evaluation of size and location of septal myocardial infarction induced by PTSMA. Infarction size correlated well with clinical indexes of infarct size.
目的
本研究旨在使用对比增强（CE）磁共振成像（MRI）评估经皮腔内间隔心肌消融术（PTSMA）对有症状的肥厚性梗阻性心肌病患者诱发心肌梗死的情况。
背景
对比增强MRI可描绘冠状动脉疾病中心肌梗死的范围，但其在乙醇诱发梗死中的作用尚未明确。
方法
对24例患者在PTSMA术前及术后1个月进行电影MRI和CE MRI检查。诱发梗死的大小和位置与左心室（LV）质量减轻、酶释放、乙醇注入量、LV流出道梯度降低及冠状动脉消融部位相关。
结果
PTSMA术后1个月，所有患者的室间隔基底段均可见局部强化。平均梗死大小为20±9 g，分别占左心室总质量的10±5%和室间隔质量的31±16%。左心室总质量从219±64 g降至205±64 g（p<0.01），室间隔质量从76±25 g降至68±22 g（p<0.01）。左心室总质量减轻超过室间隔质量减轻（p<0.01）。梗死大小与肌酸磷酸激酶-MB峰值相关（β=0.67，p<0.01）、乙醇注入量相关（β=0.47，p=0.02）、左心室和室间隔总质量减轻相关（β=0.50，p=0.02；β=0.73，p<0.01）以及梯度降低相关（β=0.63，p<0.01）。7例仅有右侧间隔梗死的患者梗死大小和梯度降低程度小于其余有左侧或透壁梗死的患者（p<0.01）。其中5例患者在靶动脉远端进行了PTSMA。
结论
对比增强MRI可详细评估PTSMA诱发的间隔心肌梗死的大小和位置。梗死大小与梗死大小的临床指标密切相关。
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