经皮冠状动脉介入治疗或旁路移植术后患者的心肌灌注和晚期钆增强联合评估：一项综合心血管磁共振方案的多中心研究。
Combined assessment of myocardial perfusion and late gadolinium enhancement in patients after percutaneous coronary intervention or bypass grafts: a multicenter study of an integrated cardiovascular magnetic resonance protocol.
机构信息
Department of Internal Medicine II, Cardiovascular MRI Unit, University of Ulm, Ulm, Germany.
出版信息
JACC Cardiovasc Imaging. 2009 Nov;2(11):1292-300. doi: 10.1016/j.jcmg.2009.05.011.
OBJECTIVES
We sought to assess the accuracy of an integrated cardiac magnetic resonance (CMR) protocol for the diagnosis of relevant coronary artery or bypass graft stenosis in patients with suspected coronary artery disease (CAD) or with previously performed percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG).
BACKGROUND
CMR is suitable for diagnosing inducible myocardial ischemia in patients with suspected CAD and has been proven to be a helpful diagnostic tool for decision of further treatment. However, little is known about its diagnostic accuracy in patients with known CAD who previously were treated by PCI or CABG.
METHODS
A total of 477 patients with suspected CAD, 236 with previous PCI, and 110 after CABG referred for coronary X-ray angiography (CXA) underwent an integrated CMR examination before CXA. Myocardial ischemia was assessed using first-pass perfusion after vasodilator stress with adenosine (140 microg/kg/min for 3 min) using gadolinium-based contrast agents (0.1 mmol/kg). Late gadolinium enhancement (LGE) was assessed 10 min after a second contrast bolus.
RESULTS
CXA demonstrated a relevant coronary vessel stenosis (> or =70% luminal reduction) in 313 (38%) patients using quantitative coronary analysis. The combination of CMR perfusion and LGE assessment for detecting a relevant coronary stenosis in patients with suspected CAD yielded sensitivity and specificity of 0.94 and 0.87, in PCI patients 0.91 and 0.90, and in CABG patients 0.79 and 0.77, respectively.
CONCLUSIONS
A combined CMR protocol for the assessment of myocardial perfusion and LGE is feasible for the detection of relevant coronary vessel stenosis even in patients who previously were treated by PCI or CAG in a routine clinical setting. However, diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Further studies are needed to optimize the clinical protocols especially in post-surgical patients.
目的
我们旨在评估综合心脏磁共振（CMR）方案在诊断疑似冠心病（CAD）患者或经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）治疗后的相关冠状动脉或旁路移植血管狭窄中的准确性。
背景
CMR 适用于诊断疑似 CAD 患者的可诱导性心肌缺血，已被证明是进一步治疗决策的有益诊断工具。然而，对于先前接受 PCI 或 CABG 治疗的已知 CAD 患者，其诊断准确性知之甚少。
方法
共有 477 例疑似 CAD 患者、236 例既往行 PCI 治疗患者和 110 例 CABG 后患者在接受冠状动脉 X 射线血管造影（CXA）前接受综合 CMR 检查。使用腺苷（140μg/kg/min 静脉滴注 3 分钟）后钆基造影剂行首过灌注评估心肌缺血，10 分钟后行延迟强化（LGE）评估。
结果
定量冠状动脉分析显示，313 例（38%）患者存在相关冠状动脉狭窄（≥70%管腔狭窄）。CMR 灌注和 LGE 联合评估疑似 CAD 患者的相关冠状动脉狭窄的敏感性和特异性分别为 0.94 和 0.87，在 PCI 患者中分别为 0.91 和 0.90，在 CABG 患者中分别为 0.79 和 0.77。
结论
在常规临床环境中，即使对于先前接受 PCI 或 CABG 治疗的患者，评估心肌灌注和 LGE 的综合 CMR 方案也可用于检测相关冠状动脉狭窄。然而，在 CABG 患者中诊断准确性降低。这可能是由于不同的血流和灌注动力学。需要进一步研究来优化临床方案，特别是在手术后患者中。
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