Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia.
J Cardiovasc Magn Reson. 2011 Oct 22;13(1):62. doi: 10.1186/1532-429X-13-62.
Adenosine stress cardiovascular magnetic resonance (CMR) has been proven an effective tool in detection of reversible ischemia. Limited evidence is available regarding its accuracy in the setting of acute coronary syndromes, particularly in evaluating the significance of non-culprit vessel ischaemia. Adenosine stress CMR and recent advances in semi-quantitative image analysis may prove effective in this area. We sought to determine the diagnostic accuracy of semi-quantitative versus visual assessment of adenosine stress CMR in detecting ischemia in non-culprit territory vessels early after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Patients were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment 3 days after successful primary-PCI for STEMI. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. Diagnostic accuracy of both methods was compared with non-culprit territory vessels utilising quantitative coronary angiography (QCA) with significant stenosis defined as ≥ 70%.
Fifty patients (age 59 ± 12 years) admitted with STEMI were evaluated. All subjects tolerated the adenosine stress CMR imaging protocol with no significant complications. The cohort consisted of 41% anterior and 59% non anterior infarctions. There were a total of 100 non-culprit territory vessels, identified on QCA. The diagnostic accuracy of semi-quantitative analysis was 96% with sensitivity of 99%, specificity of 67%, positive predictive value (PPV) of 97% and negative predictive value (NPV) of 86%. Visual analysis had a diagnostic accuracy of 93% with sensitivity of 96%, specificity of 50%, PPV of 97% and NPV of 43%.
Adenosine stress CMR allows accurate detection of non-culprit territory stenosis in patients successfully treated with primary-PCI post STEMI. Semi-quantitative analysis may be required for improved accuracy. Larger studies are however required to demonstrate that early detection of non-culprit vessel ischemia in the post STEMI setting provides a meaningful test to guide clinical decision making and ultimately improved patient outcomes.
腺苷负荷心血管磁共振（CMR）已被证实是检测可逆性缺血的有效工具。关于其在急性冠状动脉综合征中的准确性，特别是在评估非罪犯血管缺血的意义方面，证据有限。腺苷负荷 CMR 和最近在半定量图像分析方面的进展可能在这方面证明是有效的。我们旨在确定半定量与视觉评估腺苷负荷 CMR 在检测 ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后早期非罪犯血管缺血的诊断准确性。
前瞻性纳入了一项 CMR 成像方案，包括在成功进行经皮冠状动脉介入治疗（STEMI）后 3 天进行静息和腺苷负荷灌注、存活和心脏功能评估。通过首次通过腺苷灌注对 3 个短轴切片进行视觉和半定量分析，每个切片分为 6 个节段。利用定量冠状动脉造影术（QCA）比较两种方法对非罪犯血管的诊断准确性，以 ≥ 70%狭窄定义为显著狭窄。
共评估了 50 例（年龄 59±12 岁）STEMI 患者。所有患者均耐受腺苷负荷 CMR 成像方案，无明显并发症。该队列包括 41%的前壁和 59%的非前壁梗死。在 QCA 上共发现 100 个非罪犯血管。半定量分析的诊断准确性为 96%，灵敏度为 99%，特异性为 67%，阳性预测值（PPV）为 97%，阴性预测值（NPV）为 86%。视觉分析的诊断准确性为 93%，灵敏度为 96%，特异性为 50%，PPV 为 97%，NPV 为 43%。
腺苷负荷 CMR 可准确检测 STEMI 患者经 PCI 治疗后非罪犯血管狭窄。为了提高准确性，可能需要进行半定量分析。然而，需要进行更大的研究，以证明在 STEMI 后早期检测非罪犯血管缺血是否提供了有意义的测试来指导临床决策，并最终改善患者结局。
