Jensen Christoph J, Bleckmann Dominik, Eberle Holger C, Nassenstein Kai, Schlosser Thomas, Sabin Georg V, Naber Christoph K, Bruder Oliver
Department of Cardiology and Angiology, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, Essen, Germany.
Clin Res Cardiol. 2009 Oct;98(10):651-6. doi: 10.1007/s00392-009-0051-z. Epub 2009 Aug 14.
To assess myocardial salvage in acute ST segment elevation myocardial infarction (STEMI) by using contrast-enhanced CMR.
Forty-four consecutive patients (38 male; mean age 59 +/- 10 years) with a first acute STEMI underwent acute percutaneous coronary intervention with successful restoration of TIMI grade 3 flow. CMR was performed 2 +/- 1 days after reperfusion on a standard 1.5 T MR Scanner that included a steady-state free precession cine imaging for LV function and an inversion-recovery fast low angle shot (TR 8 ms, TE 4 ms, FA 25 degrees ) sequences for late gadolinium enhancement (LGE) following the injection of 0.2 mmol/kg BW gadodiamide. The myocardium at risk (MR) was approximated by the volume of myocardium exhibiting LGE and/or impaired wall motion. The myocardial salvage index (MSI) was calculated as the volume of the MR minus the volume of LGE divided by the volume of the MR. Reperfusion therapy was rated successful with an ST elevation resolution (STR) > or =70% and was considered inadequate below 70%.
Infarct size (LGE) was 17 +/- 13% of LV mass, the mean STR was 53.4 +/- 28.3%, and the MSI was 10.9 +/- 6.2%. There was a good correlation between the MSI and the STR (r = 0.695, P < 0.0001). Thirty patients had an STR below 70%, and 14 patients had an STR greater than 70%. The MSI was greater in patients with a STE resolution of more than 70% (12 +/- 11 vs. 6 +/- 3%, P < 0.0001).
A simple MR algorithm based upon the relationship of functional impairment, which includes myocardial stunning, to the extent of LGE (infarct necrosis) is in accordance with STR as a clinical marker of successful reperfusion in acute myocardial infarction.
通过使用对比增强心脏磁共振成像（CMR）评估急性ST段抬高型心肌梗死（STEMI）患者的心肌挽救情况。
44例连续的首次急性STEMI患者（38例男性；平均年龄59±10岁）接受了急性经皮冠状动脉介入治疗，TIMI 3级血流成功恢复。在再灌注后2±1天，于标准1.5T MR扫描仪上进行CMR检查，包括用于评估左心室功能的稳态自由进动电影成像，以及在注射0.2 mmol/kg体重的钆双胺后用于延迟钆增强（LGE）的反转恢复快速低角度激发（TR 8 ms，TE 4 ms，FA 25°）序列。通过表现出LGE和/或室壁运动受损的心肌体积来估算危险心肌（MR）。心肌挽救指数（MSI）计算为（MR体积减去LGE体积）除以MR体积。再灌注治疗成功的定义为ST段抬高分辨率（STR）≥70%，低于70%则认为治疗不充分。
梗死面积（LGE）占左心室质量的17±13%，平均STR为53.4±28.3%，MSI为10.9±6.2%。MSI与STR之间存在良好的相关性（r = 0.695，P < 0.0001）。30例患者的STR低于70%，14例患者的STR高于70%。STR超过70%的患者MSI更高（12±11%对6±3%，P < 0.0001）。
基于功能损害（包括心肌顿抑）与LGE（梗死坏死）范围之间关系的简单MR算法，与作为急性心肌梗死再灌注成功临床标志物的STR相符。
