Olimulder M A G M, Kraaier K, Galjee M A, Scholten M F, van Es J, Wagenaar L J, van der Palen J, von Birgelen C
Department of Cardiology, Thoraxcentrum Twente, MST, University of Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Heart Vessels. 2012 May;27(3):250-7. doi: 10.1007/s00380-011-0150-4. Epub 2011 May 20.
Histopathological studies have suggested that early revascularization for acute myocardial infarction (MI) limits the size, transmural extent, and homogeneity of myocardial necrosis. However, the long-term effect of early revascularization on infarct tissue characteristics is largely unknown. Cardiovascular magnetic resonance (CMR) imaging with contrast enhancement (CE) allows non-invasive examination of infarct tissue characteristics and left ventricular (LV) dimensions and function in one examination. A total of 69 patients, referred for cardiac evaluation for various clinical reasons, were examined with CE-CMR >1 month (median 6, range 1-213) post-acute MI. We compared patients with (n = 33) versus without (n = 36) successful early revascularization for acute MI. Cine-CMR measurements included the LV end-diastolic and end-systolic volumes (ESV), LV ejection fraction (LVEF, %), and wall motion score index (WMSI). CE images were analyzed for core, peri, and total infarct size (%), and for the number of transmural segments. In our population, patients with successful early revascularization had better LVEFs (46 ± 16 vs. 34 ± 14%; P < 0.01), superior WMSIs (0.53, range 0.00-2.29 vs. 1.42, range 0.00-2.59; P < 0.01), and smaller ESVs (121 ± 70 vs. 166 ± 82; P = 0.02). However, there was no difference in core (9 ± 6 vs. 11 ± 6%), peri (9 ± 4 vs. 10 ± 4%), and total infarct size (18 ± 9 vs. 21 ± 9%; P > 0.05 for all comparisons); only transmural extent (P = 0.07) and infarct age (P = 0.06) tended to be larger in patients without early revascularization. CMR wall motion abnormalities are significantly better after revascularization; these differences are particularly marked later after infarction. The difference in scar size is more subtle and does not reach significance in this study.
组织病理学研究表明，急性心肌梗死（MI）早期血运重建可限制心肌坏死的大小、透壁范围和均匀性。然而，早期血运重建对梗死组织特征的长期影响在很大程度上尚不清楚。采用对比增强（CE）的心血管磁共振（CMR）成像能够在一次检查中对梗死组织特征以及左心室（LV）尺寸和功能进行无创检查。共有69例因各种临床原因接受心脏评估的患者在急性心肌梗死后1个月以上（中位数为6个月，范围1 - 213个月）接受了CE - CMR检查。我们比较了急性心肌梗死成功进行早期血运重建的患者（n = 33）和未成功进行早期血运重建的患者（n = 36）。电影CMR测量包括左心室舒张末期和收缩末期容积（ESV）、左心室射血分数（LVEF，%）以及壁运动评分指数（WMSI）。对CE图像分析梗死核心、周边和总梗死面积（%）以及透壁节段数量。在我们的研究人群中，成功进行早期血运重建的患者LVEF更好（46±16 vs. 34±14%；P < 0.01）,WMSI更优（0.53，范围0.00 - 2.29 vs. 1.42，范围0.00 - 2.59；P < 0.01），ESV更小（121±70 vs. 166±82；P = 0.）。然而,梗死核心（9±6 vs. 11±6%）、周边（9±4 vs. 10±4%）和总梗死面积（18±9 vs. 21±9%；所有比较P > 0.05）没有差异；仅透壁范围（P = 0.07）和梗死年龄（P = 0.06）在未进行早期血运重建的患者中倾向于更大。血运重建后CMR壁运动异常明显改善；这些差异在梗死后更晚的时候尤为明显。瘢痕大小的差异更细微，在本研究中未达到显著水平。
