Dastidar Amardeep Ghosh, Harries Iwan, Pontecorboli Giulia, Bruno Vito D, De Garate Estefania, Moret Charlie, Baritussio Anna, Johnson Thomas W, McAlindon Elisa, Bucciarelli-Ducci Chiara
Bristol Heart Institute, University Hospitals Bristol NHS Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Int J Cardiovasc Imaging. 2019 Mar;35(3):517-527. doi: 10.1007/s10554-018-1467-1. Epub 2018 Oct 24.
Investigate whether native-T1 mapping can assess the transmural extent of myocardial infarction (TEI) thereby differentiating viable from non-viable myocardium without the use of gadolinium-contrast in both acute and chronic myocardial infarction (aMI and cMI). Sixty patients (30 cMI > 1 year and 30 aMI day 2 STEMI) and 20 healthy-controls underwent 1.5 T CMR to assess left ventricular function (cine), native-T1 mapping (MOLLI sequence 5(3)3, motion-corrected) and the presence and TEI from late gadolinium enhancement (LGE) images. Segments with TEI > 75% was considered non-viable. Gold-standard LGE-TEI was compared with corresponding segmental native-T1. Segmental native-T1 correlated significantly with TEI (R = 0.74, p < 0.001 in cMI and R = 0.57, p < 0.001 in aMI). Native-T1 differentiated segments with no LGE (1031 ± 31 ms), LGE positive but viable (1103 ± 57 ms) and LGE positive but non-viable (1206 ± 118 ms) in cMI (p < 0.01). It also differentiated segments with no LGE (1054 ± 65 m), LGE positive but viable (1135 ± 73 ms) and LGE positive but non-viable (1168 ± 71 ms) in aMI (p < 0.01). ROC analysis demonstrated excellent accuracy of native-T1 mapping compared to LGE-TEI (AUC - 0.88, p < 0.001 in cMI, vs AUC - 0.83, p < 0.001 in aMI). Native-T1 performed better in cMI than aMI (p < 0.01). In cMI a segmental T1 threshold of 1085 ms differentiated viable from non-viable segments with a sensitivity 88% and specificity of 88% whereas a T1 of 1110 ms differentiated viable from nonviable with 79% sensitivity and 79% specificity in aMI. Native-T1 mapping correlates significantly with TEI thereby differentiating between normal, viable, and non-viable myocardium with distinctive T1 profiles in aMI and cMI. Native T1-mapping to detect MI performed better in cMI compared to aMI due to absence of myocardial oedema. Native-T1 mapping holds promise for viability assessment without the need for gadolinium-contrast agent.
研究在急性和慢性心肌梗死（急性心肌梗死和慢性心肌梗死）中，天然T1映射是否可以评估心肌梗死的透壁范围（TEI），从而在不使用钆对比剂的情况下区分存活心肌和非存活心肌。60例患者（30例慢性心肌梗死>1年和30例急性心肌梗死第2天ST段抬高型心肌梗死）和20名健康对照者接受了1.5T心脏磁共振成像，以评估左心室功能（电影成像）、天然T1映射（MOLLI序列5(3)3，运动校正）以及延迟钆增强（LGE）图像中TEI的存在情况。TEI>75%的节段被认为是非存活的。将金标准LGE-TEI与相应节段的天然T1进行比较。节段性天然T1与TEI显著相关（慢性心肌梗死中R=0.74，p<0.001；急性心肌梗死中R=0.57，p<0.001）。在慢性心肌梗死中，天然T1区分了无LGE（1031±31ms）、LGE阳性但存活（1103±57ms）和LGE阳性但非存活（1206±118ms）的节段（p<0.01）。在急性心肌梗死中，它也区分了无LGE（1054±65m）、LGE阳性但存活（1135±73ms）和LGE阳性但非存活（1168±71ms）的节段（p<0.01）。ROC分析表明，与LGE-TEI相比，天然T1映射具有出色的准确性（慢性心肌梗死中AUC-0.88，p<0.001；急性心肌梗死中AUC-0.83，p<0.001）。天然T1在慢性心肌梗死中的表现优于急性心肌梗死（p<0.01）。在慢性心肌梗死中，节段性T1阈值为1085ms时区分存活和非存活节段的敏感性为88%，特异性为88%；而在急性心肌梗死中，T1为1110ms时区分存活和非存活节段的敏感性为79%，特异性为79%。天然T1映射与TEI显著相关，从而在急性心肌梗死和慢性心肌梗死中通过独特的T1特征区分正常、存活和非存活心肌。由于不存在心肌水肿，天然T1映射在检测慢性心肌梗死中的心肌梗死方面比急性心肌梗死表现更好。天然T1映射有望在无需钆对比剂的情况下进行存活评估。
