Hombach Vinzenz, Merkle Nico, Kestler Hans A, Torzewski Jan, Kochs Matthias, Marx Nikolaus, Nusser Thorsten, Burgstahler Christof, Rasche Volker, Bernhardt Peter, Kunze Markus, Wöhrle Jochen
Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Clin Res Cardiol. 2008 Oct;97(10):760-7. doi: 10.1007/s00392-008-0675-4. Epub 2008 May 30.
The purpose of this study was to evaluate whether CMRI provides characteristic findings in patients with acute chest pain suffering from ST-elevation-myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis or Tako-tsubo cardiomyopathy.
230 consecutive patients with acute chest pain underwent cardiac catheterization followed by CMRI within median 5 days. Patients were classified to suffer from STEMI (n = 102), NSTEMI (n = 89), acute myocarditis (n = 27), or Tako-tsubo cardiomyopathy (n = 12) on the synopsis of all clinical data. Wall motion abnormalities, late enhancement (LE), persistent microvascular obstruction as well ventricular volumes and functions were assessed by CMRI.
Right and left ventricular volumes were significantly different between the groups and values were highest in patients with acute myocarditis. Wall motion abnormalities were observed in 100% of STEMI, 75% of NSTEMI, 67% of acute myocarditis and 100% of Tako-tsubo patients. There was a characteristic pattern of abnormal wall motion focused on midventricular-apical segments in patients with Tako-tsubo cardiomyopathy, depending on the culprit vessel in patients with STEMI/NSTEMI and with a random distribution in patients with acute myocarditis. LE was mainly subendocardial or transmural in patients with STEMI (93.2%) or NSTEMI (62.9%). LE was diffuse, intramural or subepicardial in patients with acute myocarditis. No LE was observed in patients with Tako-tsubo cardiomyopathy. Persistent microvascular obstruction was only visualized in patients with STEMI (33%) or NSTEMI (6%).
Cardiac magnetic resonance imaging provides characteristic patterns of LE, persistent microvascular obstruction and wall motion abnormalities that allow a differentiation between patients with acute chest pain from coronary and non-coronary origin.
本研究旨在评估心脏磁共振成像（CMRI）是否能为患有ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）、急性心肌炎或应激性心肌病的急性胸痛患者提供特征性表现。
230例连续的急性胸痛患者接受了心脏导管检查，随后在中位时间5天内进行了CMRI检查。根据所有临床资料的概要，将患者分为STEMI（n = 102）、NSTEMI（n = 89）、急性心肌炎（n = 27）或应激性心肌病（n = 12）。通过CMRI评估室壁运动异常、延迟强化（LE）、持续性微血管阻塞以及心室容积和功能。
各组之间左右心室容积有显著差异，急性心肌炎患者的值最高。100%的STEMI患者、75%的NSTEMI患者、67%的急性心肌炎患者和100%的应激性心肌病患者观察到室壁运动异常。应激性心肌病患者存在以心室中部至心尖段为重点的特征性室壁运动异常模式，STEMI/NSTEMI患者取决于罪犯血管，急性心肌炎患者则呈随机分布。STEMI（93.2%）或NSTEMI（62.9%）患者的LE主要为心内膜下或透壁性。急性心肌炎患者的LE为弥漫性、壁内或心外膜下。应激性心肌病患者未观察到LE。仅在STEMI（33%）或NSTEMI（6%）患者中观察到持续性微血管阻塞。
心脏磁共振成像提供了延迟强化、持续性微血管阻塞和室壁运动异常的特征性模式，有助于区分急性胸痛的冠状动脉源性和非冠状动脉源性患者。
