心肌梗死后评估非罪犯病变的心脏磁共振：与血流储备分数的比较。
Cardiac Magnetic Resonance for Evaluating Nonculprit Lesions After Myocardial Infarction: Comparison With Fractional Flow Reserve.
机构信息
Department of Cardiology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands.
Department of Cardiology, Isala Clinics, Zwolle, the Netherlands.
出版信息
JACC Cardiovasc Imaging. 2020 Mar;13(3):715-728. doi: 10.1016/j.jcmg.2019.07.019. Epub 2019 Sep 18.
OBJECTIVES
This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis.
BACKGROUND
The agreement between CMR and FFR in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease is unknown.
METHODS
Seventy-seven patients with STEMI with at least 1 intermediate (diameter stenosis 50% to 90%) nonculprit lesion underwent CMR and invasive coronary angiography in conjunction with FFR measurements at 1 month after primary intervention. The imaging protocol included stress and rest perfusion, cine imaging, and late gadolinium enhancement. Fully quantitative, semiquantitative, and visual analysis of myocardial perfusion were compared against a reference of FFR. Hemodynamically obstructive was defined as FFR ≤0.80.
RESULTS
Hemodynamically obstructive nonculprit lesions were present in 31 (40%) patients. Visual analysis displayed an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.62 to 0.83), with a sensitivity of 73% and a specificity of 70%. For semiquantitative analysis, the relative upslope of the stress signal intensity time curve and the relative upslope derived myocardial flow reserve had respective AUCs of 0.66 (95% CI: 0.54 to 0.77) and 0.71 (95% CI: 0.59 to 0.81). Fully quantitative analysis did not augment diagnostic performance (all p > 0.05). Stress myocardial blood flow displayed an AUC of 0.76 (95% CI: 0.64 to 0.85), with a sensitivity of 69% and a specificity of 77%. Similarly, MFR displayed an AUC of 0.82 (95% CI: 0.71 to 0.90), with a sensitivity of 82% and a specificity of 71%.
CONCLUSIONS
CMR and FFR have moderate-good agreement in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease. Fully quantitative, semiquantitative, and visual analysis yield similar diagnostic performance.
目的
本研究旨在确定心脏磁共振（CMR）成像与侵入性测量分数流量储备（FFR）在评估 ST 段抬高型心肌梗死（STEMI）后非罪犯病变中的一致性。此外，我们还探讨了心肌灌注的完全定量分析是否优于半定量和视觉分析。
背景
CMR 与 FFR 在多支血管病变的 STEMI 患者非罪犯病变评估中的一致性尚不清楚。
方法
77 例 STEMI 患者至少有 1 个中等程度（直径狭窄 50%~90%）的非罪犯病变，在初次介入后 1 个月行 CMR 和侵入性冠状动脉造影检查，并进行 FFR 测量。成像方案包括负荷和静息灌注、电影成像和晚期钆增强。完全定量、半定量和视觉分析与 FFR 参考值进行比较。血流动力学阻塞定义为 FFR≤0.80。
结果
31 例（40%）患者存在血流动力学阻塞性非罪犯病变。视觉分析的曲线下面积（AUC）为 0.74（95%置信区间[CI]：0.620.83），灵敏度为 73%，特异性为 70%。对于半定量分析，应激信号强度时间曲线的相对斜率和相对斜率衍生的心肌血流储备分别有 AUC 为 0.66（95%CI：0.540.77）和 0.71（95%CI：0.590.81）。完全定量分析并未提高诊断性能（均 P>0.05）。应激心肌血流的 AUC 为 0.76（95%CI：0.640.85），灵敏度为 69%，特异性为 77%。同样，MFR 的 AUC 为 0.82（95%CI：0.71~0.90），灵敏度为 82%，特异性为 71%。
结论
CMR 和 FFR 在评估多支血管病变的 STEMI 患者非罪犯病变时具有中等良好的一致性。完全定量、半定量和视觉分析的诊断性能相似。
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