再灌注治疗的 ST 段抬高型心肌梗死患者应用多参数mapping 心血管磁共振检测梗死及挽救心肌
Interrogation of the infarcted and salvaged myocardium using multi-parametric mapping cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction patients.
机构信息
The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom.
The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom.
出版信息
Sci Rep. 2019 Jun 21;9(1):9056. doi: 10.1038/s41598-019-45449-9.
We used multi-parametric cardiovascular magnetic resonance (CMR) mapping to interrogate the myocardium following ST-segment elevation myocardial infarction (STEMI). Forty-eight STEMI patients underwent CMR at 4 ± 2 days. One matching short-axis slice of native T1 map, T2 map, late gadolinium enhancement (LGE), and automated extracellular volume fraction (ECV) maps per patient were analyzed. Manual regions-of-interest were drawn within the infarcted, the salvaged and the remote myocardium. A subgroup analysis was performed in those without MVO and with ≤75% transmural extent of infarct. For the whole cohort, T1, T2 and ECV in both the infarcted and the salvaged myocardium were significantly higher than in the remote myocardium. T1 and T2 could not differentiate between the salvaged and the infarcted myocardium, but ECV was significantly higher in the latter. In the subgroup analysis of 15 patients, similar findings were observed for T1 and T2. However, there was only a trend towards ECV being higher than ECV. In the clinical setting, current native T1 and T2 methods with the specific voxel sizes at 1.5 T could not differentiate between the infarcted and salvaged myocardium, whereas ECV could differentiate between the two. ECV was also higher in the salvaged myocardium when compared to the remote myocardium.
我们使用多参数心血管磁共振(CMR)映射来研究 ST 段抬高型心肌梗死(STEMI)后的心肌。48 例 STEMI 患者在发病后 4±2 天接受 CMR 检查。对每位患者的 1 个匹配的短轴原始 T1 图、T2 图、晚期钆增强(LGE)和自动细胞外容积分数(ECV)图进行分析。手动在梗死、挽救和远程心肌内绘制感兴趣区。对无 MVO 和梗死透壁程度≤75%的患者进行亚组分析。对于整个队列,梗死和挽救心肌的 T1、T2 和 ECV 均显著高于远程心肌。T1 和 T2 不能区分挽救和梗死心肌,但后者的 ECV 显著较高。在 15 例患者的亚组分析中,T1 和 T2 也观察到类似的发现。然而,ECV 高于 ECV 的趋势仅存在。在临床环境中,目前 1.5T 特定体素大小的原始 T1 和 T2 方法不能区分梗死和挽救的心肌,而 ECV 可以区分两者。与远程心肌相比,挽救的心肌中的 ECV 也更高。