Nanni Samuele, Lovato Luigi, Ghetti Gabriele, Vagnarelli Fabio, Mineo GianGaspare, Fattori Rossella, Saia Francesco, Marzocchi Antonio, Marrozzini Cinzia, Zompatori Maurizio, Reggiani Letizia Bacchi, Semprini Franco, Melandri Giovanni, Biagini Elena, Corsini Anna, Norscini Giulia, Rapezzi Claudio
Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
Istituto di Radiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
Int J Cardiovasc Imaging. 2017 Oct;33(10):1589-1597. doi: 10.1007/s10554-017-1149-4. Epub 2017 Apr 28.
To assess the accuracy of cardiac magnetic resonance (CMR) for the diagnosis of angiographic stenosis after percutaneous coronary intervention (PCI) of left main coronary artery (LMCA). Patients undergone in the last year PCI of unprotected LMCA and scheduled for conventional X-ray coronary angiography (CXA) were evaluated with stress perfusion CMR within 2 weeks before CXA. Main contraindications to CMR were exclusion criteria. Stress perfusion CMR was performed to follow a bolus of contrast Gadobutrol after 3 min of adenosine infusion. Between the 50 patients enrolled, only 1 did not finish the CMR protocol and 49 patients with median age 71 (65-75) years (38 male, 11 female) were analyzed. Between 784 coronary angiographic segments evaluated we found 75 stenosis or occlusions (prevalence 9.5%), but only 13 stenosis or occlusions in proximal segments (prevalence 6.6%). Patients with coronary stenosis (n = 12, 24%) showed a significantly (p = 0.002) higher prevalence of diabetes (7 of 12, 58%). At CMR examination, late gadolinium enhancement was present in 25 (51%), reversible perfusion defects in 12 (24%), and fixed perfusion defects in 6 subjects (12%). The only patient with LMCA restenosis resulted positive at perfusion CMR. The accuracy of stress perfusion CMR in diagnosis of coronary stenosis was higher when the analysis was performed only in proximal coronary arteries (95%, CI 86-99) compared to overall vessels (84%, CI 70-92). Stress perfusion CMR could strongly reduce the need for elective CXA in follow up of LMCA PCI and should be validated in further multicenter prospective studies.
评估心脏磁共振成像（CMR）在经皮冠状动脉介入治疗（PCI）左主干冠状动脉（LMCA）后诊断血管造影狭窄的准确性。对去年接受非保护左主干冠状动脉PCI且计划进行传统X线冠状动脉造影（CXA）的患者，在CXA前2周内进行负荷灌注CMR评估。CMR的主要禁忌证为排除标准。在静脉注射腺苷3分钟后，静脉注射对比剂钆布醇进行负荷灌注CMR检查。在纳入的50例患者中，仅1例未完成CMR检查方案，对49例年龄中位数为71（65 - 75）岁（男性38例，女性11例）的患者进行了分析。在评估的784个冠状动脉造影节段中，发现75处狭窄或闭塞（患病率9.5%），但近端节段仅有13处狭窄或闭塞（患病率6.6%）。冠状动脉狭窄患者（n = 12，24%）的糖尿病患病率显著更高（12例中有7例，58%，p = 0.002）。在CMR检查中，25例（51%）出现钆剂延迟强化，12例（24%）出现可逆性灌注缺损，6例（12%）出现固定性灌注缺损。唯一1例左主干冠状动脉再狭窄患者在灌注CMR检查中结果为阳性。与整体血管相比，仅对近端冠状动脉进行分析时，负荷灌注CMR诊断冠状动脉狭窄的准确性更高（95%，可信区间86 - 99），而整体血管的准确性为84%（可信区间70 - 92）。负荷灌注CMR可大幅减少左主干冠状动脉PCI随访中选择性CXA的需求，应在进一步的多中心前瞻性研究中进行验证。
