Habis Michel, Capderou André, Ghostine Saïd, Daoud Béatrice, Caussin Christophe, Riou Jean-Yves, Brenot Philippe, Angel Claude Yves, Lancelin Bernard, Paul Jean-François
Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
J Am Coll Cardiol. 2007 Mar 20;49(11):1178-85. doi: 10.1016/j.jacc.2006.12.032. Epub 2007 Mar 6.
Early evaluation of myocardial viability in acute myocardial infarction is useful to guide therapy. Therefore, we assessed 64-slice computed tomography (CT) immediately after coronary angiography in this setting.
Recent preliminary studies have shown the promising usefulness of late hyperenhancement multislice computed tomography (MSCT) for non-viability assessment.
Thirty-six patients admitted for a first acute myocardial infarction had a coronary angiogram early after admission followed by 64-slice CT without iodine reinjection. The 16 segments of the left ventricle depicted by the American Society of Echocardiography were graded: no, subendocardial, or transmural hyperenhancement. No or subendocardial hyperenhancement were expected to reflect viability. Two to 4 weeks later, the same segments' contractility was evaluated at rest. Low-dose dobutamine echocardiography was performed in case of akinetic segment at rest.
Mean delay between coronary angiography and MSCT was 24 +/- 11 min (range 7 to 51 min). We compared 576 segments evaluated by each method. Agreement was noted for 560 segments (97%) and disagreement for 16 segments (3%). Thus, 64-slice CT after coronary angiography for an acute myocardial infarction had 98% sensitivity, 94% specificity, 97% accuracy, and 99% positive and 79% negative predictive values for detecting viable myocardial segments at a very early stage of an acute myocardial infarction. On a per-patient analysis, sensitivity, specificity, accuracy, and positive and negative predictive values were 92%, 100%, 94%, and 100% and 85%, respectively.
A 64-slice CT after coronary angiography for an acute myocardial infarction is a promising method for early evaluation of viable myocardium.
急性心肌梗死时早期评估心肌存活性有助于指导治疗。因此，我们在此情况下于冠状动脉造影后立即评估64层计算机断层扫描（CT）。
近期的初步研究显示，延迟强化多层计算机断层扫描（MSCT）在非存活心肌评估方面具有良好的应用前景。
36例首次因急性心肌梗死入院的患者在入院早期接受了冠状动脉造影，随后进行了64层CT检查且未再次注射碘剂。按照美国超声心动图学会的标准，将左心室的16个节段分为：无强化、心内膜下强化或透壁强化。预期无强化或心内膜下强化反映心肌存活。2至4周后，评估相同节段静息时的收缩功能。对于静息时运动减弱的节段，进行小剂量多巴酚丁胺超声心动图检查。
冠状动脉造影与MSCT之间的平均间隔时间为24±11分钟（范围7至51分钟）。我们比较了两种方法评估的576个节段。560个节段（97%）结果一致，16个节段（3%）结果不一致。因此，急性心肌梗死患者冠状动脉造影后行64层CT检查在急性心肌梗死极早期检测存活心肌节段时，敏感性为98%，特异性为94%，准确性为97%，阳性预测值为99%，阴性预测值为79%。在按患者分析时，敏感性、特异性、准确性以及阳性和阴性预测值分别为92%、100%、94%、100%和85%。
急性心肌梗死患者冠状动脉造影后行64层CT检查是早期评估存活心肌的一种有前景的方法。
