Kwong Raymond Y, Korlakunta Hema
Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Top Magn Reson Imaging. 2008 Feb;19(1):15-24. doi: 10.1097/RMR.0B013e31817d550c.
Assessment of viability is pivotal to the prognosis of patients with chronic coronary artery disease (CAD) and left ventricular dysfunction. Patients with viable myocardium have a better prognosis with revascularization; however, patients with nonviable myocardium have worse outcomes with higher perioperative morbidity and mortality subsequent to revascularization. Cardiac magnetic resonance (CMR) imaging not only is the current reference standard technique in measuring cardiac chamber size and function and myocardial mass and volume but also provides spatially registered 2- or 3-dimensional data sets in myocardial perfusion and myocardial contrast enhancement in the same imaging session. Late gadolinium enhancement by CMR is the best current technique in discriminating myocardial scar versus viable myocardium. An extensive body of preclinical evidence has validated the detection and characterization of the morphology of infarcted tissue. In clinical studies, infarct characteristics by CMR has demonstrated a strong clinical utility in the prediction of left ventricular functional recovery and patient prognosis. In this paper, we aim to review the current CMR techniques in characterizing the spectrum of myocardial changes because of CAD, in the prediction of myocardial viability, and the current evidence of CMR's role in patient prognosis. In addition, we will also review the current literature comparing the clinical utility of CMR with other established imaging modalities in the assessment of CAD.
评估心肌存活性对于慢性冠状动脉疾病(CAD)和左心室功能障碍患者的预后至关重要。有存活心肌的患者进行血运重建后预后较好;然而,无存活心肌的患者血运重建后围手术期发病率和死亡率更高,预后较差。心脏磁共振(CMR)成像不仅是目前测量心腔大小和功能、心肌质量和容积的参考标准技术,还能在同一次成像过程中提供心肌灌注和心肌对比增强的空间配准二维或三维数据集。CMR延迟钆增强是目前区分心肌瘢痕与存活心肌的最佳技术。大量临床前证据证实了梗死组织形态学检测和特征描述的有效性。在临床研究中,CMR显示的梗死特征在预测左心室功能恢复和患者预后方面具有很强的临床实用性。在本文中,我们旨在综述当前CMR技术在表征CAD所致心肌变化谱、预测心肌存活性以及CMR在患者预后中作用的现有证据。此外,我们还将综述当前比较CMR与其他既定成像模式在CAD评估中临床实用性的文献。