心血管磁共振相对于超声心动图在急性和慢性心肌梗死检测中的增量价值。
Incremental value of cardiovascular magnetic resonance over echocardiography in the detection of acute and chronic myocardial infarction.
机构信息
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
出版信息
J Cardiovasc Magn Reson. 2013 Jan 16;15(1):5. doi: 10.1186/1532-429X-15-5.
BACKGROUND
Although echocardiography is used as a first line imaging modality, its accuracy to detect acute and chronic myocardial infarction (MI) in relation to infarct characteristics as assessed with late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is not well described.
METHODS
One-hundred-forty-one echocardiograms performed in 88 first acute ST-elevation MI (STEMI) patients, 2 (IQR1-4) days (n = 61) and 102 (IQR92-112) days post-MI (n = 80), were pooled with echocardiograms of 36 healthy controls. 61 acute and 80 chronic echocardiograms were available for analysis (53 patients had both acute and chronic echocardiograms). Two experienced echocardiographers, blinded to clinical and CMR data, randomly evaluated all 177 echocardiograms for segmental wall motion abnormalities (SWMA). This was compared with LGE-CMR determined infarct characteristics, performed 104 ± 11 days post-MI. Enhancement on LGE-CMR matched the infarct-related artery territory in all patients (LAD 31%, LCx 12% and RCA 57%).
RESULTS
The sensitivity of echocardiography to detect acute MI was 78.7% and 61.3% for chronic MI; specificity was 80.6%. Undetected MI were smaller, less transmural, and less extensive (6% [IQR3-12] vs. 15% [IQR9-24], 50 ± 14% vs. 61 ± 15%, 7 ± 3 vs. 9 ± 3 segments, p < 0.001 for all) and associated with higher left ventricular ejection fraction (LVEF) and non-anterior location as compared to detected MI (58 ± 5% vs. 46 ± 7%, p < 0.001 and 82% vs. 63%, p = 0.03). After multivariate analysis, LVEF and infarct size were the strongest independent predictors of detecting chronic MI (OR 0.78 [95%CI 0.68-0.88], p < 0.001 and OR 1.22 [95%CI0.99-1.51], p = 0.06, respectively). Increasing infarct transmurality was associated with increasing SWMA (p < 0.001).
CONCLUSIONS
In patients presenting with STEMI, and thus a high likelihood of SWMA, the sensitivity of echocardiography to detect SWMA was higher in the acute than the chronic phase. Undetected MI were smaller, less extensive and less transmural, and associated with non-anterior localization and higher LVEF. Further work is needed to assess the diagnostic accuracy in patients with non-STEMI.
背景
尽管超声心动图被用作一线成像方式，但它在检测与晚期钆增强心血管磁共振（LGE-CMR）评估的梗死特征相关的急性和慢性心肌梗死（MI）方面的准确性尚未得到很好的描述。
方法
共纳入 88 例首次急性 ST 段抬高型心肌梗死（STEMI）患者的 141 次超声心动图检查，其中 61 次在急性 MI 后 2（IQR1-4）天（n=61），80 次在慢性 MI 后 102（IQR92-112）天（n=80），并与 36 例健康对照者的超声心动图进行了汇总。61 次急性和 80 次慢性超声心动图可用于分析（53 例患者均有急性和慢性超声心动图）。2 名经验丰富的超声心动图医师，对临床和 CMR 数据不知情，随机评估了所有 177 次超声心动图的节段性壁运动异常（SWMA）。将其与 MI 后 104±11 天行 LGE-CMR 确定的梗死特征进行比较。在所有患者中，LGE-CMR 上的增强与梗死相关动脉区域相匹配（LAD 31%，LCx 12%和 RCA 57%）。
结果
超声心动图检测急性 MI 的敏感性为 78.7%，慢性 MI 为 61.3%；特异性为 80.6%。未检测到的 MI 更小、透壁程度更低、范围更小（6%[IQR3-12] vs. 15%[IQR9-24]，50±14% vs. 61±15%，7±3 节 vs. 9±3 节，均 p<0.001），与左心室射血分数（LVEF）更高和非前壁位置有关（58±5% vs. 46±7%，均 p<0.001，82% vs. 63%，p=0.03）。多变量分析后，LVEF 和梗死面积是检测慢性 MI 的最强独立预测因素（OR 0.78[95%CI 0.68-0.88]，p<0.001 和 OR 1.22[95%CI0.99-1.51]，p=0.06）。梗死透壁程度的增加与 SWMA 的增加相关（p<0.001）。
结论
在 STEMI 患者中，即出现 SWMA 的可能性较高，超声心动图检测 SWMA 的敏感性在急性 MI 阶段高于慢性 MI 阶段。未检测到的 MI 更小、范围更小、透壁程度更低，与非前壁位置和较高的 LVEF 有关。需要进一步的研究来评估在非 STEMI 患者中的诊断准确性。
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