Departament of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
J Cardiovasc Magn Reson. 2011 Jul 25;13(1):35. doi: 10.1186/1532-429X-13-35.
This study sought to prospectively and directly compare three cardiovascular magnetic resonance (CMR) viability parameters: inotropic reserve (IR) during low-dose dobutamine (LDD) administration, late gadolinium enhancement transmurality (LGE) and thickness of the non-contrast-enhanced myocardial rim surrounding the scar (RIM). These parameters were examined to evaluate their value as predictors of segmental left ventricular (LV) functional recovery in patients with LV systolic dysfunction undergoing surgical or percutaneous revascularisation. The second goal of the study was to determine the optimal LDD-CMR- and LGE-CMR-based predictor of significant (≥ 5%) LVEF improvement 6 months after revascularisation.
In 46 patients with chronic coronary artery disease (CAD) (63 ± 10 years of age, LVEF 35 ± 8%), wall motion and the above mentioned CMR parameters were evaluated before revascularisation. Wall motion and LGE were repeatedly assessed 6 months after revascularisation. Logistic regression analysis models were created using 333 dysfunctional segments at rest.
An LGE threshold value of 50% (LGE50) and a RIM threshold value of 4 mm (RIM4) produced the best sensitivities and specificities for predicting segmental recovery. IR was superior to LGE50 for predicting segmental recovery. When the areas under the ROC curves is compared, the combined viability prediction model (LGE50 + IR) was significantly superior to IR alone in all analysed sets of segments, except the segments with an LGE from 26% to 75% (p = 0.08). The RIM4 model was not superior to the LGE50 model. A myocardial segment was considered viable if it had no LGE or had any LGE and produced IR during LDD stimulation. ROC analysis demonstrated that ≥ 50% of viable segments from all dysfunctional and revascularised segments in a patient predict significant improvement in LVEF with a 69% sensitivity and 70% specificity (AUC 0.7, p = 0.05). The cut-off of ≥ 3 viable segments was a less useful predictor of significant global LV recovery.
LDD-CMR is superior to LGE-CMR as a predictor of segmental recovery. The advantage is greatest in the segments with an LGE from 26% to 75%. The RIM cut-off value of 4 mm had no superiority over the LGE cut-off value of 50% in predicting the segmental recovery. Patients with ≥ 50% of viable segments from all dysfunctional and revascularised had a tendency to improve LVEF by ≥ 5% after revascularisation.
本研究旨在前瞻性地直接比较三种心血管磁共振（CMR）存活参数：低剂量多巴酚丁胺（LDD）给药期间的变力储备（IR）、晚期钆增强透壁性（LGE）和围绕疤痕的非对比增强心肌边缘的厚度（RIM）。检查这些参数是为了评估它们作为预测左心室（LV）收缩功能障碍患者接受手术或经皮血运重建后节段性左心室（LV）功能恢复的价值。该研究的第二个目标是确定基于 LDD-CMR 和 LGE-CMR 的最佳预测因子，以预测血运重建后 6 个月时 LVEF 有显著（≥5%）改善。
在 46 例慢性冠状动脉疾病（CAD）患者（63±10 岁，LVEF 35±8%）中，在血运重建前评估壁运动和上述 CMR 参数。在血运重建后 6 个月重复评估壁运动和 LGE。使用 333 个静息时功能障碍节段建立逻辑回归分析模型。
LGE 阈值为 50%（LGE50）和 RIM 阈值为 4mm（RIM4）可产生最佳的敏感性和特异性，以预测节段性恢复。IR 优于 LGE50 预测节段性恢复。当比较 ROC 曲线下面积时，在所有分析的节段组中，除了 LGE 为 26%至 75%的节段（p=0.08）外，联合存活预测模型（LGE50+IR）均明显优于单独使用 IR。RIM4 模型并不优于 LGE50 模型。如果心肌节段无 LGE 或存在任何 LGE 并在 LDD 刺激下产生 IR，则该节段被认为具有存活能力。ROC 分析表明，患者所有功能障碍和血运重建节段中≥50%的存活节段可预测 LVEF 有显著改善，敏感性为 69%，特异性为 70%（AUC 0.7，p=0.05）。≥3 个存活节段的截止值是预测整体 LV 恢复的一个不太有用的指标。
LDD-CMR 优于 LGE-CMR，是节段性恢复的预测指标。在 LGE 为 26%至 75%的节段中，优势最大。RIM 截止值为 4mm 与 LGE 截止值为 50%相比，在预测节段恢复方面没有优势。在血运重建后，所有功能障碍和血运重建节段中≥50%的存活节段的患者倾向于 LVEF 有≥5%的改善。
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