Division of Cardiology, Pulmonology and Vascular Diseases, Department of Medicine, University Hospital Aachen, Aachen, Germany.
Clin Res Cardiol. 2010 May;99(5):293-300. doi: 10.1007/s00392-010-0117-y. Epub 2010 Feb 12.
We sought to determine whether the thickness of the non-contrast-enhanced myocardial rim (RIM) predicts recovery of territorial myocardial function after revascularization in chronic ischemic cardiomyopathy (ICM).
Non-contrast-enhanced dysfunctional myocardium at late gadolinium-enhanced CMR depicts the presence of viable myocardium.
In 29 patients (65 +/- 8 years) with ICM (EF 33 +/- 10), ceCMR and cine images were acquired 5 +/- 10 days before revascularization. Cine images were repeated after 6 months. Regional wall thickness, wall thickening and RIM were determined in each of 12 segments per short-axis slice (4-8/patient), which were assigned to the respective supplying coronary artery (LAD, LCX and RCA). A threshold for normal wall-thickening was derived from a control group (n = 14; 52 +/- 17 years). Functional improvement at follow-up was defined as wall thickening >2 mm.
Of the 1,896 analyzed segments, 655 segments showed severe dysfunction. At follow-up, 307 segments demonstrated functional improvement. The RIM differed between segments with and without improvement (6.6 +/- 2.4 mm vs. 2.8 +/- 2.0 mm; p < 0.0001). The area under the receiver operator characteristic (ROC) for predicting overall functional recovery was 0.91 (95%, CI 0.88-0.93, p < 0.001). A RIM of 4.0 mm predicted functional recovery after revascularization of the supplying coronary artery with a sensitivity and a specificity of 88 and 82% for the LAD, 96 and 86% for the RCA and 88 and 83% for the LCX, respectively.
RIM may be a useful marker for predicting territorial functional recovery after revascularization in patients with chronic ICM.
我们旨在确定非对比增强心肌边缘（RIM）的厚度是否可预测慢性缺血性心肌病（ICM）血运重建后区域性心肌功能的恢复。
晚期钆增强心脏磁共振（CMR）中的非对比增强功能障碍性心肌描绘出存活心肌的存在。
在 29 名 ICM 患者（65±8 岁）中，在血运重建前 5±10 天获取 ceCMR 和电影图像。在 6 个月后重复电影图像。在每个短轴切片的 12 个节段中（4-8/患者）确定区域壁厚度、壁增厚和 RIM，并将其分配给相应的供血冠状动脉（左前降支、回旋支和右冠状动脉）。从对照组（n=14；52±17 岁）中得出正常壁增厚的阈值。随访时的功能改善定义为壁增厚>2mm。
在分析的 1896 个节段中，有 655 个节段显示严重功能障碍。在随访时，有 307 个节段显示功能改善。有改善和无改善的节段之间的 RIM 存在差异（6.6±2.4mm与 2.8±2.0mm；p<0.0001）。ROC 曲线下面积（AUC）用于预测整体功能恢复的 AUC 为 0.91（95%CI 0.88-0.93，p<0.001）。RIM 为 4.0mm 时，可预测供血冠状动脉血运重建后的功能恢复，对于左前降支，其敏感性和特异性分别为 88%和 82%，对于右冠状动脉，敏感性和特异性分别为 96%和 86%，对于回旋支，敏感性和特异性分别为 88%和 83%。
RIM 可能是预测慢性 ICM 患者血运重建后区域性功能恢复的有用标志物。
