心脏移植术后患者不同钆增强模式的患病率。
Prevalence of different gadolinium enhancement patterns in patients after heart transplantation.
作者信息
Steen Henning, Merten Constanze, Refle Sonja, Klingenberg Roland, Dengler Thomas, Giannitsis Evangelos, Katus Hugo A
机构信息
Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany.
出版信息
J Am Coll Cardiol. 2008 Sep 30;52(14):1160-7. doi: 10.1016/j.jacc.2008.05.059.
OBJECTIVES
Transplant coronary artery disease (TCAD) limits long-term survival after heart transplantation (HTX). We hypothesized that contrast-enhanced magnetic resonance imaging (CE-MRI) detects chronic TCAD-related myocardial infarctions (MIs), even in patients with angiographically classified mild TCAD.
BACKGROUND
Coronary angiography underestimates the TCAD-degree, subsequently missing occluded small coronary arteries and resulting MI. CE-MRI as a noninvasive imaging technique identifies infarct-typical MI and myocardial fibrosis.
METHODS
CE-MRI (gadolinium: 0.2 mmol/kg/bw) was performed in 53 HTX patients on a 1.5-T MRI scanner (Philips, Best, the Netherlands). Infarct-typical CE-MRI areas were classified as: I=<or=25%, II=25% to 50%, III=50% to 75% and IV=>or=75%. Infarct-atypical forms were divided into diffuse, spotted, intramural, and infero-septal. Coronary angiography results were reviewed qualitatively with the TCAD score (TCAD I=mild evidence; II=30% to 75%, III=>or=75% stenosis). Groups were compared with analysis of variance (statistically significant p values<or=0.05).
RESULTS
Infarct-typical CE-MRI was already present in TCAD I+II, increased significantly between groups (I=23%, II=33%, III=84%, p<0.05), and involved only single coronary territories in TCAD I but multiple vessels in TCAD II+III. Infarct-atypical CE-MRI was equally distributed across all TCAD stages (I=50% vs. II=58% vs. III=42%, p=NS) without relation to a coronary territory. Patients with only infarct-atypical CE-MRI were associated with significantly better left ventricular function compared with patients with infarct-typical or combined CE-MRI patterns (ejection fraction=66+/-6% vs. 45+/-16% or 60+/-13%; end-diastolic volume=139+/-32 ml vs. 148+/-27 ml or 164+/-43 ml; end-systolic volume=47+/-15 ml vs. 81+/-27 ml or 69+/-38 ml, p<or=0.05).
CONCLUSIONS
CE-MRI allows identification of silent MI in apparently event-free HTX patients and is able to disclose myocardial fibrosis already in patients with absent or mild angiographic TCAD. CE-MRI might be helpful to establish an earlier TCAD diagnosis and to intensify medical treatment. Future studies are necessary to test prognostic implications associated with CE-MRI patterns.
目的
移植冠状动脉疾病（TCAD）限制了心脏移植（HTX）后的长期生存。我们假设，对比增强磁共振成像（CE-MRI）能够检测出慢性TCAD相关的心肌梗死（MI），即使是血管造影显示为轻度TCAD的患者。
背景
冠状动脉造影会低估TCAD的程度，进而遗漏闭塞的小冠状动脉以及由此导致的心肌梗死。CE-MRI作为一种非侵入性成像技术，可识别典型梗死性心肌梗死和心肌纤维化。
方法
对53例HTX患者在1.5-T MRI扫描仪（飞利浦，荷兰贝斯特）上进行CE-MRI（钆：0.2 mmol/kg/体重）检查。典型梗死性CE-MRI区域分为：I≤25%，II = 25%至50%，III = 50%至75%，IV≥75%。非典型梗死形式分为弥漫性、斑点状、壁内和下间隔型。采用TCAD评分对冠状动脉造影结果进行定性评估（TCAD I =轻度证据；II = 30%至75%，III≥75%狭窄）。采用方差分析对各组进行比较（统计学显著p值≤0.05）。
结果
在TCAD I + II组中已出现典型梗死性CE-MRI，各组间显著增加（I = 23%，II = 33%，III = 84%，p < 0.05），在TCAD I组中仅累及单个冠状动脉区域，而在TCAD II + III组中累及多个血管。非典型梗死性CE-MRI在所有TCAD阶段分布相同（I = 50% vs. II = 58% vs. III = 42%，p =无统计学意义），与冠状动脉区域无关。与具有典型梗死性或联合CE-MRI模式的患者相比，仅具有非典型梗死性CE-MRI的患者左心室功能明显更好（射血分数= 66±6% vs. 45±16%或60±13%；舒张末期容积= 139±32 ml vs. 148±27 ml或164±43 ml；收缩末期容积= 47±15 ml vs. 81±27 ml或69±38 ml，p≤0.05）。
结论
CE-MRI能够在表面上无事件的HTX患者中识别无症状心肌梗死，并且能够在血管造影显示无或轻度TCAD的患者中检测出心肌纤维化。CE-MRI可能有助于更早地诊断TCAD并加强药物治疗。未来有必要进行研究以测试与CE-MRI模式相关的预后意义。
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