Division of Cardiology, New York Methodist Hospital, Brooklyn, NY 11215, USA.
Atherosclerosis. 2010 Sep;212(1):166-70. doi: 10.1016/j.atherosclerosis.2010.05.002. Epub 2010 May 12.
Inflammation has been shown to be a major component in the pathophysiology of acute coronary syndrome (ACS). In patients presenting with acute myocardial infarction (AMI), a critical component of the ACS spectrum, multiple coronary arteries are involved during this inflammatory process. In addition to the coronary vasculature, the inflammatory cascade has also been shown to affect the carotid arteries and possibly the aorta.
To assess the involvement of the aorta during AMI by cardiac magnetic resonance (CMR).
We prospectively evaluated the aortic wall by CMR in 123 patients. 78 patients were enrolled from the emergency department (ED), who presented with chest pain and were classified as either: (1) AMI: elevated troponin levels and typical chest pain or (2) non-cardiac chest pain (CP): negative troponins and a normal stress test or normal cardiac catheterization. We compared these 2 groups to a group of 45 asymptomatic diabetic patients. The descending thoracic aortic wall area (AWA) and maximal aortic wall thickness (AWT) were measured using a double inversion recovery T-2 weighted, ECG-gated, spin echo sequence by CMR.
Patients with AMI were older, more likely to smoke, had a higher incidence of claudication, and had higher CRP levels. The AWA and maximal AWT were greater in patients who presented to the ED with ACS (2.11+/-0.17 mm(2), and 3.17+/-0.19 mm, respectively) than both patients presenting with non-cardiac CP (1.52+/-0.58 mm(2), p<0.001; and 2.57+/-0.10 mm, p<0.001) and the diabetic patients (1.38+/-0.58 mm(2), p<0.001; and 2.30+/-0.131 mm, p<0.001). The difference in the aortic wall characteristics remained significant after correcting for body mass index, hyperlipidemia, statins and C-reactive protein. There was no difference in maximal AWT or AWA between patients with non-cardiac CP and patients with diabetes.
Patients with AMI have a significantly greater maximal aortic wall thickness and area compared to patients with non-cardiac CP. Longitudinal studies are needed to assess whether this increase is due to inflammation or a higher atherosclerotic burden.
炎症已被证实是急性冠状动脉综合征（ACS）病理生理学的主要组成部分。在急性心肌梗死（AMI）患者中，ACS 谱的一个关键组成部分，多个冠状动脉在这个炎症过程中受到影响。除了冠状动脉血管外，炎症级联反应也被证明会影响颈动脉，可能还会影响主动脉。
通过心脏磁共振（CMR）评估 AMI 期间主动脉的受累情况。
我们前瞻性地评估了 123 例患者的主动脉壁，其中 78 例患者从急诊科（ED）入院，胸痛且分为以下两种情况：（1）AMI：肌钙蛋白水平升高和典型胸痛或（2）非心脏性胸痛（CP）：肌钙蛋白阴性和正常应激试验或正常心导管检查。我们将这两组与 45 例无症状糖尿病患者进行了比较。通过 CMR 上的双反转恢复 T2 加权、ECG 门控、自旋回波序列测量降主动脉壁面积（AWA）和最大主动脉壁厚度（AWT）。
AMI 患者年龄较大，更可能吸烟，跛行发生率更高，CRP 水平更高。在 ED 就诊的 ACS 患者中，AWA 和最大 AWT 较大（分别为 2.11+/-0.17mm²和 3.17+/-0.19mm），明显高于非心脏性 CP 患者（分别为 1.52+/-0.58mm²，p<0.001；和 2.57+/-0.10mm，p<0.001）和糖尿病患者（分别为 1.38+/-0.58mm²，p<0.001；和 2.30+/-0.131mm，p<0.001）。在校正体重指数、高脂血症、他汀类药物和 C 反应蛋白后，主动脉壁特征的差异仍然显著。非心脏性 CP 患者和糖尿病患者的最大 AWT 或 AWA 之间无差异。
与非心脏性 CP 患者相比，AMI 患者的最大主动脉壁厚度和面积明显更大。需要进行纵向研究来评估这种增加是由于炎症还是更高的动脉粥样硬化负担所致。
