冠状动脉疾病所致慢性心力衰竭患者左心室血流及冠状动脉血流储备的磁共振成像测量

Magnetic resonance imaging measurement of left ventricular blood flow and coronary flow reserve in patients with chronic heart failure due to coronary artery disease.

作者信息

Aras A, Anik Y, Demirci A, Balci N C, Kozdag G, Ural D, Komsuoglu B

出版信息

Acta Radiol. 2007 Dec;48(10):1092-1100. doi: 10.1080/02841850701545748.

DOI:10.1080/02841850701545748

PMID:17963087

Abstract

BACKGROUND

Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure(CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC)velocity-encoded cine (VEC) magnetic resonance imaging (MRI).

PURPOSE

To quantify and compare global left ventricular (LV) perfusion and CFR inpatients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients.

MATERIAL AND METHODS

Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n=11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability.Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress.

RESULTS

At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group(P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P=0.083, P=0.037).

CONCLUSION

A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF.

摘要

背景

冠状窦血流反映整体心脏灌注，已被用于评估心肌血流储备，而在慢性心力衰竭（CHF）中该储备会降低。冠状血流储备（CFR）可通过相位对比（PC）速度编码电影（VEC）磁共振成像（MRI）来测量。

目的

通过使用PC VEC MRI测量冠状窦血流，对CHF患者和健康对照组的整体左心室（LV）灌注及CFR进行量化和比较，并将其与同一患者的整体LV灌注、节段性首过灌注及存活情况相关联。

材料与方法

对20例缺血性起源的CHF患者及健康对照组（n = 11）在静息状态下以及静脉注射双嘧达莫诱导的药物应激后进行心脏MRI检查。MRI检查方案包括电影MRI、VEC MRI、首过灌注及用于评估存活情况的延迟对比增强MRI。通过测量所有受试者静息状态下VEC MRI上的冠状窦血流来量化整体LV灌注。CFR被确定为药物应激前后整体LV灌注的比值。