Veselova T N, Merkulova I N, Iarovaia E B, Ternovoĭ S K, Ruda M Ia
Kardiologiia. 2013;53(2):10-8.
Aim of the study was to assess perfusion defect and viability of the myocardium by the method of multispiral computed tomography (MSCT) in patients with ST-elevation acute myocardial infarction (AMI) and to assess their prognostic role in development of remodeling of the left ventricle (LV). We included into the study 117 patients with AMI. MSCT with intravenous contrast enhancement was carried out on days 3-4 and at 12 months after AMI. In the arterial phase we estimated volume of myocardial perfusion defect, LV end diastolic and end systolic volumes (LVEDV and LVESV), and LV ejection fraction (EF). Three types of myocardial opacification were distinguished on tomograms in delayed phase of MSCT: type I - subendocardial residual defect (RD), type II - transmural RD, type III - transmural delayed hyper enhancement (DE). Patients were divided in 3 groups: (1) with subendocardial RD (n=63), (2) with transmural RD (n=28), (3) with transmural DE (n=26). Development of LV remodeling was registered if at repeat MSCT LVEDV increased more or equal 20% from baseline. In patients with signs of viable myocardium (group 1) volume of perfusion defect was substantially smaller than in patients with nonviable myocardium (groups 2 and 3): 1cm3 (0.4-2.4) vs. 7.3 cm3 (5.3-10.0) and 6.3 cm3 (5.0-15.0), respectively, p<0.001. Compared with groups 2 and 3 patients of group 1 more often were female (p=0.04), had inferior MI (p<0.001), and spontaneous reperfusion (p<0.001). After 12 months LV remodeling was registered in 19.3% of patients, all had signs of nonviable myocardium in more or equal 3 LV segments. In patients with perfusion defect more or equal 10 cm3 probability of development of LV remodeling exceeded 50%. Disturbances of perfusion abnormalities and number of nonviable LV segments were main predictors of LV remodeling.
本研究旨在通过多层螺旋计算机断层扫描（MSCT）方法评估ST段抬高型急性心肌梗死（AMI）患者心肌灌注缺损及存活心肌情况，并评估其在左心室（LV）重构发生中的预后作用。我们纳入了117例AMI患者。在AMI后第3 - 4天及12个月时进行静脉造影增强的MSCT检查。在动脉期，我们评估心肌灌注缺损体积、左心室舒张末期和收缩末期容积（LVEDV和LVESV）以及左心室射血分数（EF）。在MSCT延迟期的断层图像上区分出三种心肌强化类型：I型 - 心内膜下残余缺损（RD），II型 - 透壁性RD，III型 - 透壁性延迟强化（DE）。患者分为3组：（1）心内膜下RD组（n = 63），（2）透壁性RD组（n = 28），（3）透壁性DE组（n = 26）。如果在重复MSCT检查时LVEDV较基线增加≥20%，则记录为发生LV重构。有存活心肌迹象的患者（第1组）灌注缺损体积明显小于无存活心肌的患者（第2组和第3组）：分别为1cm³（0.4 - 2.4）与7.3cm³（5.3 - 10.0）和6.3cm³（5.0 - 15.0），p<0.001。与第2组和第3组相比，第1组患者女性更多（p = 0.04），下壁心肌梗死更多（p<0.001），且自发再灌注更多（p<0.001）。12个月后，19.3%的患者出现LV重构，所有患者在≥3个LV节段有非存活心肌迹象。灌注缺损≥10cm³的患者发生LV重构的概率超过50%。灌注异常及非存活LV节段数量是LV重构的主要预测因素。
