Division of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376 Stuttgart, Germany.
Eur Heart J. 2009 Dec;30(23):2869-79. doi: 10.1093/eurheartj/ehp328. Epub 2009 Aug 20.
Only few data are available regarding a direct comparison of both non-invasive CMR and invasive EMB with respect to conformity of procedure-derived diagnoses in the same patients. The aim of this study was to elucidate the diagnostic performance of non-invasive cardiovascular magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB) in patients with troponin-I (TnI) positive acute chest pain in the absence of significant coronary artery disease (CAD).
One thousand one hundred and seventy-four consecutive patients who were admitted with TnI-positive acute chest pain between March 2004 and July 2007 underwent coronary angiography. In 1012 patients (86%), significant CAD (stenosis >50%) was detected as underlying reason for the acute chest pain. In 82 out of the remaining 162 patients without significant CAD, further workup was performed including both CMR and EMB. Cardiovascular magnetic resonance imaging alone enabled a diagnosis in 66/82 (80%) and EMB alone in 72/82 (88%) patients (P = 0.31). Myocarditis was the most frequent diagnosis by both CMR and EMB in this cohort and was detected with a higher frequency by EMB (58 vs. 81%; P < 0.001). With the combined approach comprising CMR and EMB, a final diagnosis could be established applying the 'Believe-The-Positive-Rule' in 78/82 patients (95%). This combined approach turned out to yield more diagnoses than either CMR (P < 0.001) or EMB (P = 0.03) as single techniques, respectively. Comparison of diagnostic CMR procedures with the corresponding diagnostic EMBs demonstrated a substantial match of diagnoses (kappa = 0.70).
Cardiovascular magnetic resonance imaging and EMB have good diagnostic performances as single techniques in patients with TnI-positive acute chest pain in the absence of CAD. The combined application of CMR and EMB yields a considerable diagnostic synergy by overcoming some limitations of CMR and EMB as individually applied techniques.
关于非侵入性 CMR 和有创心内膜心肌活检（EMB）在同一患者中对程序衍生诊断的一致性，仅有少量数据。本研究的目的是阐明在无明显冠状动脉疾病（CAD）的情况下，肌钙蛋白 I（TnI）阳性急性胸痛患者中，心血管磁共振成像（CMR）和心内膜心肌活检（EMB）的诊断性能。
2004 年 3 月至 2007 年 7 月期间，连续 1174 例 TnI 阳性急性胸痛患者入院接受冠状动脉造影。在 1012 例（86%）患者中，检测到明显 CAD（狭窄>50%）为急性胸痛的根本原因。在其余 162 例无明显 CAD 的患者中，进行了进一步检查，包括 CMR 和 EMB。CMR 单独可诊断 82 例中的 66 例（80%），EMB 单独可诊断 82 例中的 72 例（88%）（P=0.31）。CMR 和 EMB 最常见的诊断是心肌炎，且 EMB 检出率更高（58%比 81%；P<0.001）。应用 CMR 和 EMB 的联合方法，按照“Believe-The-Positive-Rule”在 82 例患者中的 78 例（95%）中可建立最终诊断。与 CMR 或 EMB 单一技术相比，联合方法的诊断数量更多（P<0.001 和 P=0.03）。与相应的 EMB 相比，诊断性 CMR 程序与诊断性 EMB 之间存在高度匹配（kappa=0.70）。
在无 CAD 的 TnI 阳性急性胸痛患者中，CMR 和 EMB 作为单一技术具有良好的诊断性能。CMR 和 EMB 的联合应用通过克服 CMR 和 EMB 作为单独应用技术的一些局限性，产生了相当大的诊断协同作用。
