多排CT心肌强化模式能否预测心肌梗死后的功能改善？

Is functional improvement after myocardial infarction predicted with myocardial enhancement patterns at multidetector CT?

作者信息

Lessick Jonathan, Dragu Robert, Mutlak Diab, Rispler Shmuel, Beyar Rafael, Litmanovich Diana, Engel Ahuva, Agmon Yoram, Kapeliovich Michael, Hammerman Haim, Ghersin Eduard

机构信息

Department of Cardiology, Rambam Health Care Campus, Haaliya St, Haifa 31096, Israel.

出版信息

Radiology. 2007 Sep;244(3):736-44. doi: 10.1148/radiol.2443061397. Epub 2007 Aug 9.

DOI:10.1148/radiol.2443061397

PMID:17690323

Abstract

PURPOSE

To prospectively evaluate the sensitivity of myocardial early perfusion defects (EDs) and late enhancement (LE) at multidetector computed tomography (CT) following acute myocardial infarction (AMI) to predict segment myocardial dysfunction and myocardial functional recovery (MFR), by using echocardiography as the reference standard.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained. Twenty-six patients (25 men, one woman; mean age, 53 years+/-9 [standard deviation]), underwent baseline multidetector CT, coronary angiography, and echocardiography within a week of AMI and a follow-up echocardiography at 3 months. ED, LE, and late hypoattenuation were compared with regional left ventricular function and MFR. A logistic regression model and generalized estimating equation analysis were applied to estimate the predictive effect of ED and LE. Differences between groups were evaluated by using nonpaired Student t tests.

RESULTS

All EDs and LE corresponded with AMI location determined by using angiography and echocardiography. For occluded arteries (n=5), no relationship was found between the presence of ED or LE and MFR. For patent arteries (n=21), presence of LE had a respective sensitivity and specificity of 73% and 85% for predicting follow-up segment dysfunction, compared with 57% and 90% for ED. In abnormal baseline segments, nonrecovery was clearly related to the presence and size of segment defect area for both ED (odds ratio: 1.95 [95% confidence interval: 0.9, 4.1] per square centimeter) and LE (odds ratio: 1.85 [95% confidence interval: 1.2, 2.9] per square centimeter). Segments that recovered had significantly lower prevalence of ED and LE, and if present, were significantly smaller than in segments remaining abnormal (P<.05).

CONCLUSION

The presence and size of ED and LE at multidetector CT is closely related to follow-up segment myocardial dysfunction and MFR.

摘要

目的

以超声心动图作为参考标准，前瞻性评估急性心肌梗死（AMI）后多排螺旋计算机断层扫描（CT）心肌早期灌注缺损（ED）和延迟强化（LE）预测节段性心肌功能障碍和心肌功能恢复（MFR）的敏感性。

材料与方法

获得机构审查委员会批准并取得知情同意。26例患者（25例男性，1例女性；平均年龄53岁±9[标准差]）在AMI后1周内接受基线多排螺旋CT、冠状动脉造影和超声心动图检查，并在3个月时进行随访超声心动图检查。将ED、LE和晚期低密度与局部左心室功能和MFR进行比较。应用逻辑回归模型和广义估计方程分析来评估ED和LE的预测效果。采用非配对Student t检验评估组间差异。

结果

所有ED和LE均与通过血管造影和超声心动图确定的AMI部位相对应。对于闭塞动脉（n = 5），未发现ED或LE的存在与MFR之间存在关联。对于通畅动脉（n = 21），LE预测随访节段功能障碍的敏感性和特异性分别为73%和85%，而ED分别为57%和90%。在基线节段异常的情况下，ED（每平方厘米优势比：1.95[95%置信区间：0.9，4.1]）和LE（每平方厘米优势比：1.85[95%置信区间：1.2，2.9]）的节段缺损面积的存在和大小与无恢复明显相关。恢复的节段ED和LE的患病率显著较低，且如果存在，其面积明显小于仍异常的节段（P<0.05）。