Palazzuoli Alberto, Beltrami Matteo, Gennari Luigi, Dastidar A Ghosh, Nuti Ranuccio, McAlindon Elisa, Angelini Gianni D, Bucciarelli-Ducci Chiara
Cardiology Unit Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Siena, Italy,
Int J Cardiovasc Imaging. 2015 Jun;31(5):1037-44. doi: 10.1007/s10554-015-0657-3. Epub 2015 Apr 12.
Myocardial infarction (MI) results in myocardial scarring which can have an impact on left ventricular (LV) stiffness and contractile function, ultimately leading to reduced LV systolic function and LV remodelling, However some concerns about the relation between scar extension and segmental wall motion contractility is not enough clear. Thus, the association between myocardial scar, LV regional and global function and LV remodeling should be investigated. We studied the relationship between scar extension, wall motion score index (WMSI), LV dimensions and systolic function in a group of patients with previous MI by cardiac magnetic resonance (CMR). 133 patients with previous (>6 month) MI were retrospectively enrolled in the study. Indexed end-systolic volume (ESVi), indexed end-diastolic volume (EDVi), LV ejection fraction (EF), stroke volume (SV), LV mass were measured using CMR. WMSI and sum scar score (SSS) were also measured following AHA\ACC criteria giving an arbitrary cut-off to distinguish larger from restricted late gadolinium enhancement (LGE) area. A total of 2261 segments were studied: regional wall motion abnormalities were present in 1032 segments (45%) and 724 (32%) showed presence of MI (LGE). WMSI correlated significantly with EF (r = -0.87, p < 0.0001) in all patients and in both patients with EF ≥ 40% (r = -0.77, p < 0.0001) and EF < 40% (r = -0.68, p < 0.0001). WMSI also correlated significantly with SSS (r = 0.57, p < 0.0001). The correlation between WMSI and SSS was more significant in patients with transmural MI (WMSI 2.1 ± 0.5 and SSS 17 ± 8; r = 0.55, p < 0.0001) than with non transmural MI (WMSI 1.6 ± 0.7 and SSS 6 ± 4; r = 0.34 and p = 0.02). A significant correlation was also found between EF and SSS (r = -0.55 and p < 0.0001) and between SSS and LV indexed volumes (EDVi; r = 0.44, p < 0.0001 and ESVi; r = 0.51, p < 0.0001). Infarct transmurality and extension as expressed as SSS assessed with cardiac MRI has an impact on global and regional systolic function. A multi-parametric score measuring WMSI scar transmurality and extension, could better identify an increased cardiac remodeling after coronary event.
心肌梗死（MI）会导致心肌瘢痕形成，这会影响左心室（LV）的僵硬度和收缩功能，最终导致左心室收缩功能降低和左心室重构。然而，关于瘢痕扩展与节段性室壁运动收缩性之间的关系，目前仍存在一些尚不明确的问题。因此，有必要研究心肌瘢痕、左心室局部和整体功能以及左心室重构之间的关联。我们通过心脏磁共振成像（CMR）研究了一组既往有心肌梗死病史患者的瘢痕扩展、室壁运动评分指数（WMSI）、左心室尺寸与收缩功能之间的关系。本研究回顾性纳入了133例既往心肌梗死病史超过6个月的患者。采用CMR测量了左心室收缩末期容积指数（ESVi）、舒张末期容积指数（EDVi）、左心室射血分数（EF）、每搏输出量（SV）和左心室质量。同时按照美国心脏协会（AHA）/美国心脏病学会（ACC）标准测量了WMSI和瘢痕总分（SSS），并设定了一个任意的截断值，以区分大面积与局限性延迟钆增强（LGE）区域。共研究了2261个节段：1032个节段（45%）存在节段性室壁运动异常，724个节段（32%）显示存在心肌梗死（LGE）。在所有患者中，以及在EF≥40%（r = -0.77，p < 0.0001）和EF < 40%（r = -0.68，p < 0.0001）的患者中，WMSI均与EF显著相关（r = -0.87，p < 0.0001）。WMSI也与SSS显著相关（r = 0.57，p < 0.0001）。与非透壁性心肌梗死患者（WMSI为1.6±0.7，SSS为6±4；r = 0.34，p = 0.02）相比，透壁性心肌梗死患者中WMSI与SSS之间的相关性更强（WMSI为2.1±0.5，SSS为17±8；r = 0.55，p < 0.0001）。EF与SSS之间（r = -0.55，p < 0.0001）以及SSS与左心室容积指数（EDVi；r = 0.44，p < 0.0001和ESVi；r = 0.51，p < 0.0001）之间也均存在显著相关性。通过心脏MRI评估的梗死透壁性和扩展程度（以SSS表示）对整体和局部收缩功能均有影响。一个测量WMSI、瘢痕透壁性和扩展程度的多参数评分，可能能够更好地识别冠状动脉事件后心脏重构的增加情况。
Zotero 插件