Kitabata Hironori, Imanishi Toshio, Kubo Takashi, Takarada Shigeho, Kashiwagi Manabu, Matsumoto Hiroki, Tsujioka Hiroto, Ikejima Hideyuki, Arita Yu, Okochi Keishi, Kuroi Akio, Ueno Satoshi, Kataiwa Hideaki, Tanimoto Takashi, Yamano Takashi, Hirata Kumiko, Nakamura Nobuo, Tanaka Atsushi, Mizukoshi Masato, Akasaka Takashi
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
JACC Cardiovasc Imaging. 2009 Mar;2(3):263-72. doi: 10.1016/j.jcmg.2008.11.013.
The purpose of this study was to investigate whether microvascular resistance index (MVRI) immediately after primary percutaneous coronary intervention (PCI) can predict the transmural extent of infarction (TEI) defined by contrast-enhanced cardiac magnetic resonance (ce-CMR) in patients with anterior acute myocardial infarction (MI).
The degree of microvascular damage is an important determinant of myocardial viability and clinical outcomes in acute MI. A novel dual-sensor (pressure and Doppler velocity) guidewire has the ability to evaluate microvascular damage. ce-CMR can accurately discriminate transmural from nontransmural MI, and the TEI by ce-CMR can predict future improvement in contractile function.
In 27 patients immediately after primary PCI for a first anterior acute MI, MVRI, coronary flow reserve (CFR), deceleration time of diastolic velocity (DDT), and zero flow pressure (Pzf) were measured with a dual-sensor guidewire. TEI was graded from 1 to 4 based on the transmural extent of hyperenhanced tissue (1 = 0% to 25% of left ventricular wall thickness, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = 76% to 100%). Infarct size by ce-CMR was also calculated.
Peak creatine kinase-myocardial band values were significantly correlated with MVRI (r = 0.77, p < 0.0001), CFR (r = -0.69, p < 0.0001), DDT (r = -0.75, p = 0.0001), and Pzf (r = 0.75, p < 0.0001). Also, infarct size by ce-CMR was significantly correlated with MVRI (r = 0.78, p < 0.0001), CFR (r = -0.67, p < 0.0001), DDT (r = -0.70, p < 0.0001), and Pzf (r = 0.72, p = 0.0002). Receiver-operating characteristic curve analyses of MVRI, CFR, DDT, and Pzf for predicting transmural MI (TEI-grade 4) demonstrated that the area under the curve tended to be higher for MVRI (0.885) than those for CFR (0.848), DDT (0.862), and Pzf (0.853). The best cut-off value for MVRI was 3.25 mm Hg x cm(-1) x s (sensitivity 75%, specificity 89%). Moreover, increased MVRI was significantly related to increased TEI-grade (p < 0.0001).
MVRI measured immediately after primary PCI is a useful predictor for the TEI in patients with anterior acute MI.
本研究旨在探讨急性前壁心肌梗死患者直接经皮冠状动脉介入治疗（PCI）后即刻的微血管阻力指数（MVRI）是否能够预测由对比增强心脏磁共振成像（ce-CMR）所定义的梗死透壁范围（TEI）。
微血管损伤程度是急性心肌梗死中心肌存活能力及临床预后的重要决定因素。一种新型双传感器（压力和多普勒速度）导丝能够评估微血管损伤。ce-CMR能够准确区分透壁性心肌梗死与非透壁性心肌梗死，且ce-CMR所测得的TEI能够预测未来收缩功能的改善情况。
对27例首次发生急性前壁心肌梗死并接受直接PCI治疗的患者，使用双传感器导丝测量MVRI、冠状动脉血流储备（CFR）、舒张期速度减速时间（DDT）以及零流量压力（Pzf）。根据强化组织的透壁范围将TEI分为1至4级（1级=左心室壁厚度的0%至25%，2级=26%至50%，3级=51%至75%，4级=76%至100%）。同时计算ce-CMR所测得的梗死面积。
肌酸激酶同工酶峰值与MVRI（r = 0.77，p < 0.0001）、CFR（r = -0.69，p < 0.0001）、DDT（r = -0.75，p = 0.0001）以及Pzf（r = 0.75，p < 0.0001）显著相关。此外，ce-CMR所测得的梗死面积与MVRI（r = 0.78，p < 0.0001）、CFR（r = -0.67，p < 0.0001）、DDT（r = -0.70，p < 0.0001）以及Pzf（r = 0.72，p = 0.0002）显著相关。MVRI、CFR、DDT以及Pzf预测透壁性心肌梗死（TEI 4级）的受试者工作特征曲线分析显示，MVRI的曲线下面积（0.885）倾向于高于CFR（0.848）、DDT（0.862）以及Pzf（0.853）。MVRI的最佳截断值为3.25 mmHg×cm⁻¹×s（敏感性75%，特异性89%）。此外，MVRI升高与TEI分级增加显著相关（p < 0.0001）。
直接PCI术后即刻测得的MVRI是急性前壁心肌梗死患者TEI的有效预测指标。
