Monmeneu José V, Bodí Vicente, López-Lereu María P, Sanchis Juan, Núñez Julio, Chaustre Fabián, Husser Oliver, Merlos Pilar, Bonanad Clara, Miñana Gema, Chorro Francisco J, Llácer Angel
Unidad de Imagen Cardiaca (ERESA), Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez 17, Valencia, Spain.
Rev Esp Cardiol (Engl Ed). 2012 Jul;65(7):634-41. doi: 10.1016/j.recesp.2012.01.024. Epub 2012 May 12.
To evaluate by cardiovascular magnetic resonance those factors related to the amount of salvaged myocardium after a myocardial infarction and its value in predicting adverse ventricular remodeling.
One hundred eighteen patients admitted for a first ST elevation myocardial infarction (primary angioplasty, 65 patients; a pharmacoinvasive strategy, 53 patients) underwent magnetic resonance (6 [5-8] days and 6 months; n=83). The myocardial salvage index was quantitatively assessed as the percentage of area at risk (T2-weighted sequences) not showing late enhancement.
Myocardial salvage index >31% (median) was associated with a shorter time to reperfusion (153 min vs 258 min), a lower rate of diabetes (12% vs 32%), shorter time to magnetic resonance, and better cardiovascular parameters (P<.05 for all analyses). There were no significant differences depending on the reperfusion method. In a logistic regression analysis, delayed reperfusion (odds ratio=0.42 [0.29-0.63]; P<.0001), diabetes (odds ratio=0.32 [0.11-0.99]; P<.05) and a longer time to the performance of magnetic resonance (odds ratio=0.86 [0.76-0.97]; P<.05) were independently related to a lower probability of a myocardial salvage index >31%. Predictors of increased left ventricular end-systolic volume at 6 months were the number of segments showing an extent of transmural necrosis >50% (odds ratio =1.51 [1.21-1.90]; P<.0001) and left ventricular end-systolic volume at one week (odds ratio=1.12 [1.06-1.18]; P<.0001).
Cardiovascular magnetic resonance enables the quantification of the salvaged myocardium after myocardial infarction. The celerity with which reperfusion therapy is administered constitutes its most important predictor. The possible effect of a delay in the performance of magnetic resonance on myocardial salvage needs to be confirmed. Salvaged myocardium does not improve the value of magnetic resonance for predicting adverse remodeling.
通过心血管磁共振评估与心肌梗死后挽救心肌量相关的因素及其在预测不良心室重构中的价值。
118例因首次ST段抬高型心肌梗死入院的患者（65例行直接血管成形术；53例行药物介入策略）接受了磁共振检查（分别在6[5 - 8]天和6个月时进行；n = 83）。心肌挽救指数通过未显示延迟强化的危险区域面积百分比（T2加权序列）进行定量评估。
心肌挽救指数>31%（中位数）与再灌注时间较短（153分钟对258分钟）、糖尿病发生率较低（12%对32%）、磁共振检查时间较短以及较好的心血管参数相关（所有分析P<0.05）。根据再灌注方法无显著差异。在逻辑回归分析中，延迟再灌注（比值比 = 0.42[0.29 - 0.63]；P<0.0001）、糖尿病（比值比 = 0.32[0.11 - 0.99]；P<0.05）和磁共振检查时间较长（比值比 = 0.86[0.76 - 0.97]；P<0.05）与心肌挽救指数>31%的可能性较低独立相关。6个月时左心室收缩末期容积增加的预测因素是透壁坏死范围>50%的节段数（比值比 = 1.51[1.21 - 1.90]；P<0.0001）和1周时的左心室收缩末期容积（比值比 = 1.12[1.06 - 1.18]；P<0.0001）。
心血管磁共振能够对心肌梗死后挽救的心肌进行定量分析。再灌注治疗实施速度是其最重要的预测因素。磁共振检查延迟对心肌挽救的可能影响需要进一步证实。挽救的心肌并不能提高磁共振预测不良重构的价值。
