Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy.
ETISAN, Rome, Italy.
J Nucl Cardiol. 2018 Apr;25(2):496-505. doi: 10.1007/s12350-016-0751-5. Epub 2017 Jan 11.
Myocardial necrosis after myocardial infarction (MI) is common; extent and severity are however variable. The pattern is recognized by myocardial perfusion imaging (MPI) as fixed perfusion defects (FPD). The fate of such FPD is not well appraised. This study addressed this important issue in a large number of patients undergoing serial MPI in relation to type of intervening therapy.
Patients with prior MI or MPI-evidence of myocardial necrosis undergoing serial MPI without intervening acute coronary syndromes were included. The fate of necrosis by MPI on per-patient and per-region analysis was analyzed, factoring also the impact of intervening coronary revascularization (CR).
A total of 3691 patients with 25,837 regions were identified, including 1413 (38.3%) subjects with 3358 (13.0%) regions exhibiting necrosis. Serial MPI after 29±21 months confirmed the persistent presence of myocardial necrosis FPD in the vast majority of patients and regions (86%); the consistency was even higher in the presence of moderate or severe necrosis (99%). Neither type nor site of CR significantly impacted on the presence and extent of myocardial necrosis at multivariable analysis.
The finding of myocardial necrosis by MPI remains highly consistent over time, and is not significantly altered by CR.
心肌梗死后心肌坏死很常见；但其范围和严重程度各不相同。心肌灌注成像（MPI）可识别这种固定性灌注缺损（FPD）的模式。然而，对于这种 FPD 的结局，我们还没有很好地评估。本研究在大量接受连续 MPI 检查的患者中，针对干预性治疗的类型，探讨了这一重要问题。
纳入了先前患有心肌梗死或 MPI 有心肌坏死证据、且无急性冠状动脉综合征介入治疗的患者。通过对每位患者和每个区域的 MPI 分析，对坏死的结局进行了分析，同时还考虑了介入性冠状动脉血运重建（CR）的影响。
共纳入了 3691 例患者，共 25837 个区域，包括 1413 例（38.3%）患者的 3358 个（13.0%）区域存在坏死。29±21 个月后进行的连续 MPI 检查证实，绝大多数患者和区域（86%）仍存在心肌坏死 FPD，在存在中度或重度坏死的情况下，这种一致性甚至更高（99%）。多变量分析显示，CR 的类型和部位对心肌坏死的存在和程度均无显著影响。
MPI 检测到的心肌坏死在时间上具有高度一致性，且不会因 CR 而显著改变。
