Weir-McCall Jonathan R, Fitzgerald Kerrie, Papagiorcopulo Carla J, Gandy Stephen J, Lambert Matthew, Belch Jill J F, Cavin Ian, Littleford Roberta, Macfarlane Jennifer A, Matthew Shona Z, Nicholas R Stephen, Struthers Allan D, Sullivan Frank M, Waugh Shelley A, White Richard D, Houston J Graeme
Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK.
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK.
Eur Heart J Cardiovasc Imaging. 2017 Jun 1;18(6):657-662. doi: 10.1093/ehjci/jew155.
Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI).
A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m2, P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function.
Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.
利用心脏磁共振成像的延迟钆增强（LGE）技术，在普通人群中发现19%-30%的未被识别的心肌梗死（UMIs）。然而，这些研究集中在未经过筛选的队列，包括那些已知患有心血管疾病（CVD）的人群。本研究的目的是使用磁共振成像（MRI）确定非高危人群中UMIs的患病率。
共有5000名年龄大于40岁、无CVD病史且根据ATP-III风险评分评估的10年CVD风险小于20%的志愿者被纳入泰赛德心脏事件筛查研究。那些B型利钠肽（BNP）水平高于其性别特异性中位数的人被邀请进行全身磁共振血管造影和心脏磁共振成像，包括LGE评估。LGE被分类为无、UMI或非特异性。共有1529名志愿者完成了成像研究；其中，53名（3.6%）因数据缺失或LGE图像质量不佳而被排除。其余1476名中的10名（0.67%）显示有LGE。其中，3名（0.2%）符合UMI，而7名是非特异性的，发生在心肌中层（n = 4）、心外膜（n = 1）或右心室插入点（n = 2）。患有UMI的患者BNP显著更高[中位数116（范围31-133）对22.6（5-175）pg/mL，P = 0.015]，射血分数更低[54.6（36-62）对68.9（38-89）%，P = 0.007]，收缩末期容积更大[36.3（27-61）对21.7（5-65）mL/m2，P = 0.014]。患有非特异性LGE的患者舒张压更低[68（54-70）对72（46-98）mmHg，P = 0.013]，但其心脏功能无差异。
尽管先前的报告描述了老年人群中UMI的高患病率，但在一个主要为中年人的队列中，心血管风险处于中等或低水平的人发生未被识别的心肌梗死的风险非常低。
