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缺血性心肌病男性患者中对比增强磁共振成像与多巴酚丁胺磁共振成像的头对头比较。

Head-to-head comparison between contrast-enhanced magnetic resonance imaging and dobutamine magnetic resonance imaging in men with ischemic cardiomyopathy.

作者信息

Kaandorp Theodorus A M, Bax Jeroen J, Schuijf Joanne D, Viergever Eric P, van Der Wall Ernst E, de Roos Albert, Lamb Hildo J

机构信息

Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Am J Cardiol. 2004 Jun 15;93(12):1461-4. doi: 10.1016/j.amjcard.2004.03.003.

Abstract

Contrast-enhanced magnetic resonance imaging (MRI) can predict functional recovery after revascularization. Segments with small, subendocardial scars have a large likelihood of recovery, and segments with transmural infarction have a small likelihood of recovery. Segments with an intermediate extent of infarction have an intermediate likelihood of recovery, and therefore, additional information is needed. Accordingly, the transmurality of infarction on contrast-enhanced MRI was compared with low-dose dobutamine MRI to further define viability in 48 patients. Regional contractile dysfunction was determined by cine MRI at rest (17-segment model), and contractile reserve was determined using low-dose dobutamine infusion. Contrast-enhanced MRI was performed to assess the extent of scar tissue. A total of 338 segments (41%) were dysfunctional, with 61% having contractile reserve. Most segments (approximately 75%) with small, subendocardial scars (hyperenhancement scores 1 or 2) had contractile reserve, whereas contractile reserve was not frequently (17%) observed in segments with transmural infarction (hyperenhancement score 4) (p <0.05). Of segments with an intermediate infarct transmurality (hyperenhancement score 3), contractile reserve was observed in 42%, whereas 58% did not have contractile reserve. In conclusion, the agreement between contrast-enhanced MRI and low-dose dobutamine MRI is large in the extremes (subendocardial scars and transmural scars), and contrast-enhanced MRI may be sufficient to assess the likelihood of the recovery of function after revascularization. However, 61% of segments with an intermediate extent of scar tissue on MRI have contractile reserve and 39% lack contractile reserve. In these segments, low-dose dobutamine MRI may be needed to optimally differentiate myocardium with large and small likelihoods of functional recovery after revascularization.

摘要

对比增强磁共振成像(MRI)能够预测血运重建后的功能恢复情况。心内膜下小面积瘢痕的节段恢复可能性大,而透壁性梗死的节段恢复可能性小。梗死范围中等的节段恢复可能性中等,因此需要更多信息。据此,对48例患者进行对比增强MRI上梗死透壁程度与小剂量多巴酚丁胺MRI的比较,以进一步明确心肌存活性。通过静息状态下的电影MRI(17节段模型)确定局部收缩功能障碍,并使用小剂量多巴酚丁胺输注来确定收缩储备。进行对比增强MRI以评估瘢痕组织的范围。共有338个节段(41%)存在功能障碍,其中61%具有收缩储备。大多数心内膜下小面积瘢痕(强化评分1或2)的节段(约75%)具有收缩储备,而在透壁性梗死(强化评分4)的节段中收缩储备并不常见(17%)(p<0.05)。梗死透壁程度中等(强化评分3)的节段中,42%观察到有收缩储备,而58%没有收缩储备。总之,对比增强MRI与小剂量多巴酚丁胺MRI在极端情况(心内膜下瘢痕和透壁瘢痕)下的一致性较高,对比增强MRI可能足以评估血运重建后功能恢复的可能性。然而,MRI显示瘢痕组织范围中等的节段中,61%具有收缩储备,39%缺乏收缩储备。在这些节段中,可能需要小剂量多巴酚丁胺MRI来最佳地区分血运重建后功能恢复可能性大与小的心肌。

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