Piotrowska-Kownacka Dorota, Kownacki Łukasz, Kochman Janusz, Kołodzińska Agnieszka, Kobylecka Małgorzata, Królicki Leszek
1 Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
Department of Radiology, European Health Center, Otwock, Poland.
Pol J Radiol. 2015 Dec 13;80:536-43. doi: 10.12659/PJR.895396. eCollection 2015.
Restoration of blood flow in epicardial coronary artery in patients with acute myocardial infarction can, but does not have to restore efficient blood flow in coronary circulation. The aim of the study was a direct comparison of microvascular obstruction (MVO) detected by rest and stress perfusion imaging and gadolinium enhancement obtained 2 min. (early MVO) and 15 min. (delayed MVO) post contrast.
MATERIAL/METHODS: 106 patients with first anterior myocardial infarction were studied. Cardiovascular magnetic resonance (CMR) was performed 5±2 days after primary percutaneous coronary intervention (pPCI). Stress and rest perfusion imaging was performed as well as early and delayed gadolinium enhancement and systolic function assessment. Scoring of segmental function, perfusion defect, MVO and scar transmurality was performed in 16 segment left ventricular model.
The prevalence of MVO varies significantly between imaging techniques ranging from 48.8% for delayed MVO to 94% with stress perfusion. Median sum of scores was significantly different for each technique: stress perfusion 13 (7; 18), rest perfusion 3 (0.5; 6), early MVO 3 (0; 8), delayed MVO 0 (0; 4); p<0.05. Infarct size, stress and rest perfusion defects were independent predictors of LV EF at discharge from hospital.
Imaging protocol has a significant impact on MVO results. The study is the first to describe a stress-induced MVO in STEMI patients. Further research is needed to evaluate its impact on a long term prognosis.
急性心肌梗死患者心外膜冠状动脉血流的恢复能够，但不一定能恢复冠状动脉循环中的有效血流。本研究的目的是直接比较静息和负荷灌注成像检测到的微血管阻塞（MVO）以及注射造影剂后2分钟（早期MVO）和15分钟（延迟MVO）获得的钆增强情况。
材料/方法：对106例首次发生前壁心肌梗死的患者进行研究。在初次经皮冠状动脉介入治疗（pPCI）后5±2天进行心血管磁共振（CMR）检查。同时进行负荷和静息灌注成像、早期和延迟钆增强以及收缩功能评估。在16节段左心室模型中对节段功能、灌注缺损、MVO和梗死透壁性进行评分。
不同成像技术检测到的MVO患病率差异显著，从延迟MVO的48.8%到负荷灌注时的94%不等。每种技术的评分中位数有显著差异：负荷灌注13（7；18），静息灌注3（0.5；6），早期MVO 3（0；8），延迟MVO 0（0；4）；p<0.05。梗死面积、负荷和静息灌注缺损是出院时左心室射血分数的独立预测因素。
成像方案对MVO结果有显著影响。本研究首次描述了ST段抬高型心肌梗死（STEMI）患者中的负荷诱导性MVO。需要进一步研究以评估其对长期预后的影响。
