Clinic of Internal Medicine II, University of Ulm, Ulm, Germany.
JACC Cardiovasc Imaging. 2010 Aug;3(8):833-9. doi: 10.1016/j.jcmg.2010.05.013.
This study sought to evaluate the prevalence of subclinical myocardial infarctions with cardiovascular magnetic resonance imaging (CMRI) in patients with patent foramen ovale (PFO) after cryptogenic cerebral ischemic events.
A thrombotic mass passing a PFO may embolize in cerebral but also in coronary arteries, resulting in both cerebral and myocardial ischemic events. CMRI with late gadolinium enhancement (LGE) analysis is the most sensitive imaging technique to detect small myocardial infarctions.
PFO patients (n = 74) with a first cryptogenic cerebral ischemic event without a clinical history for myocardial infarction underwent CMRI and coronary angiography. Right and left ventricular volumes and ejection fractions were measured by CMRI. LGE imaging was performed after administration of gadolinium-diethylenetriaminepentaacetic acid. The presence of atrial septal aneurysm (ASA) was evaluated by transesophageal echocardiography.
LGE was detected in 8 of 74 (10.8%) patients. LGE pattern was transmural or subendocardial. Patients with LGE and those without did not differ in cardiovascular risk factors, type of ischemic event, presence of ASA, right and left ventricular volumes, and ejection fractions. LGE volume was small and comprised only 7.9 +/- 2.4% of left ventricular muscle mass. Coronary artery disease was ruled out in 7 of 8 patients with LGE. There was a trend towards a larger PFO size in patients with LGE compared with patients without LGE (13.2 +/- 4.1 mm vs. 16.0 +/- 2.8 mm, p = 0.06).
Subclinical myocardial infarctions determined in CMRI were observed in 10.8% of patients with PFO after a first cryptogenic cerebral ischemic event. Our results strengthen the pathophysiologic role of a PFO with paradoxical embolism in patients with cryptogenic cerebral ischemic events.
本研究旨在评估卵圆孔未闭（PFO）患者在发生隐源性脑缺血事件后，通过心血管磁共振成像（CMRI）检测到的无症状性心肌梗死的发生率。
通过 PFO 传递的血栓可能会栓塞在脑部，也可能栓塞在冠状动脉中，从而导致脑和心肌缺血事件。使用钆延迟增强（LGE）分析的 CMRI 是检测小面积心肌梗死的最敏感成像技术。
首次发生隐源性脑缺血事件且无心肌梗死病史的 PFO 患者（n=74）接受了 CMRI 和冠状动脉造影检查。CMRI 测量左右心室容积和射血分数。在注射钆二乙三胺五乙酸后进行 LGE 成像。经食管超声心动图评估房间隔瘤（ASA）的存在。
74 例患者中，8 例（10.8%）检测到 LGE。LGE 模式为透壁或心内膜下。有 LGE 和无 LGE 的患者在心血管危险因素、缺血事件类型、ASA 存在、左右心室容积和射血分数方面没有差异。LGE 体积较小，仅占左心室肌肉质量的 7.9±2.4%。7 例有 LGE 的患者排除了冠状动脉疾病。与无 LGE 的患者相比，有 LGE 的患者的 PFO 更大（13.2±4.1mm vs.16.0±2.8mm，p=0.06）。
在首次隐源性脑缺血事件后，通过 CMRI 确定了 10.8%的 PFO 患者存在无症状性心肌梗死。我们的研究结果强化了 PFO 伴反常栓塞在隐源性脑缺血事件患者中的病理生理作用。
