Department of Radiology and Nuclear Medicine, Division of Diagnostics and Intervention, Ullevål, 0407, Oslo, Norway.
Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
Eur Radiol. 2019 Feb;29(2):941-950. doi: 10.1007/s00330-018-5588-7. Epub 2018 Jul 6.
The aim of this study was to investigate the association between TIMI myocardial perfusion (TMP) grading acute and cardiac magnetic resonance (CMR) first-pass perfusion early and at 4 months in patients with ST-segment-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).
One hundred ninety-eight STEMI patients were recruited from the POSTEMI study. TMP grade was assessed after PCI; CMR was performed at day 2 and after 4 months. Signal intensity was measured on first-pass perfusion images, and a maximum contrast enhancement index (MCE) was calculated.
Patients with TMP grade 2-3 (n = 108) after PCI had significantly better EF (59 ± 10 vs. 51 ± 13, p < 0.001) and smaller infarct volume (12 ± 8 vs. 19 ± 12 %, p < 0.001) at 4 months compared with patients with TMP grade 0-1 (n = 81). MCE in the infarcted (MCEi) and remote myocardium (MCEr) improved from early to follow-up CMR, MCEi from 94 ± 56 to 126 ± 59, p < 0.001, and MCEr from 112 ± 51 to 127 ± 50, p < 0.001. In patients with the lowest CMR perfusion early, perfusion at 4 months remained decreased compared with the other groups, MCEi 108 ± 75 vs. 133 ± 51, p = 0.01, and MCEr 115 ± 41 vs. 131 ± 52, p = 0.047.
TMP grade and early CMR first-pass perfusion were associated with CMR outcomes at 4 months. First-pass perfusion improved after 4 months in the infarcted and remote myocardium. However, in patients with the lowest CMR perfusion early, perfusion was still reduced after 4 months.
• Cardiac magnetic resonance myocardial first-pass perfusion and TMP grading after successful PCI helps to assess risk in patients with ST elevation myocardial infarction. • Cardiac magnetic resonance myocardial first-pass perfusion shows that microvascular perfusion after ST elevation myocardial infarction can be impaired in both infarcted and non-infarcted myocardium. • Microvascular perfusion improves over time in patients with ST elevation myocardial infarction treated with primary PCI.
本研究旨在探讨经皮冠状动脉介入治疗（PCI）后 ST 段抬高型心肌梗死（STEMI）患者 TIMI 心肌灌注（TMP）分级与心脏磁共振（CMR）早期和 4 个月首过灌注之间的关系。
从 POSTEMI 研究中招募了 198 名 STEMI 患者。在 PCI 后评估 TMP 分级；在第 2 天和 4 个月进行 CMR。在首过灌注图像上测量信号强度，并计算最大对比增强指数（MCE）。
PCI 后 TMP 分级 2-3 级（n=108）的患者在 4 个月时的 EF（59±10 比 51±13，p＜0.001）和梗死体积（12±8 比 19±12%，p＜0.001）明显优于 TMP 分级 0-1 级（n=81）。梗死区（MCEi）和远隔心肌（MCEr）的 MCE 从早期 CMR 到随访 CMR 均有所改善，MCEi 从 94±56 增加到 126±59，p＜0.001，MCEr 从 112±51 增加到 127±50，p＜0.001。在早期 CMR 灌注最低的患者中，与其他组相比，4 个月时的灌注仍较低，MCEi 为 108±75 比 133±51，p=0.01，MCEr 为 115±41 比 131±52，p=0.047。
TMP 分级和早期 CMR 首过灌注与 4 个月时的 CMR 结果相关。梗死区和远隔心肌的首过灌注在 4 个月后有所改善。然而，在早期 CMR 灌注最低的患者中，4 个月后的灌注仍较低。
