MRI 用于测量 ST 段抬高型心肌梗死血运重建后治疗效果：系统评价和荟萃回归分析。

MRI for measuring therapy efficiency after revascularisation in ST-segment elevation myocardial infarction: a systematic review and meta-regression analysis.

机构信息

Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany.

Institute of Medical Statistics, Computer Sciences and Documentation, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany.

出版信息

BMJ Open. 2020 Sep 28;10(9):e034359. doi: 10.1136/bmjopen-2019-034359.

DOI:10.1136/bmjopen-2019-034359

PMID:32988935

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7523216/

Abstract

OBJECTIVE

To summarise existing data on the relation between the time from symptom onset until revascularisation (time to reperfusion) and the myocardial salvage index (MSI) calculated as proportion of non-necrotic myocardium inside oedematous myocardium on T2-weighted and T1-weighted late gadolinium enhancement MRI after ST-segment elevation myocardial infarction (STEMI).

METHODS

Studies including patients with revascularised STEMI and stating both the time to reperfusion and the MSI measured by T2-weighted and T1-weighted late gadolinium enhancement MRI were searched in MEDLINE, EMBASE and ISI Web of Science until 16 May 2020. A mixed effects model was used to evaluate the relation between the time to reperfusion and the MSI. The gender distribution and mean age in included patient groups, the timing of MRI, used MRI sequences and image interpretation methodology were included in the mixed effects model to explore between-study heterogeneity.

RESULTS

We included 38 studies with 5106 patients. The pooled MSI was 42.6% (95% CI: 38.1 to 47.1). The pooled time to reperfusion was 3.8 hours (95% CI: 3.5 to 4.0). Every hour of delay in reperfusion was associated with an absolute decrease of 13.1% (95% CI: 11.5 to 14.6; p<0.001) in the MSI. Between-study heterogeneity was considerable (σ=167.8). Differences in the gender distribution, timing of MRI and image interpretation among studies explained 45.2% of the between-study heterogeneity.

CONCLUSIONS

The MSI on T2-weighted and T1-weighted late gadolinium enhancement MRI correlates inversely with the time to reperfusion, which indicates that cardioprotection achieved by minimising the time to reperfusion leads to a higher MSI. The analysis revealed considerable heterogeneity between studies. The heterogeneity could partly be explained by differences in the gender distribution, timing and interpretation of MRI suggesting that the MRI-assessed MSI is not only influenced by cardioprotective therapy but also by patient characteristics and MRI parameters.

摘要

目的

总结 ST 段抬高型心肌梗死（STEMI）患者再灌注时间与心肌挽救指数（MSI）之间的关系，MSI 通过 T2 加权和钆延迟增强 MRI 计算，反映水肿心肌内非坏死心肌的比例。

方法

检索 MEDLINE、EMBASE 和 ISI Web of Science 数据库，查找截至 2020 年 5 月 16 日发表的接受再血管化治疗的 STEMI 患者，并报告再灌注时间和 T2 加权和 T1 加权钆延迟增强 MRI 测量的 MSI 的研究。采用混合效应模型评估再灌注时间与 MSI 之间的关系。纳入研究的患者性别分布和平均年龄、MRI 时间、使用的 MRI 序列和图像解读方法均纳入混合效应模型，以探索研究间异质性。

结果

共纳入 38 项研究，共 5106 例患者。汇总的 MSI 为 42.6%（95%CI：38.1%~~47.1%）。再灌注时间为 3.8 小时（95%CI：3.5~~4.0 小时）。再灌注每延迟 1 小时，MSI 绝对减少 13.1%（95%CI：11.5%~14.6%；p<0.001）。研究间异质性较大（σ=167.8）。性别分布、MRI 时间和图像解读方法的差异解释了 45.2%的研究间异质性。

结论

T2 加权和 T1 加权钆延迟增强 MRI 的 MSI 与再灌注时间呈负相关，这表明通过尽量减少再灌注时间实现的心脏保护会导致更高的 MSI。分析显示研究间存在较大的异质性。这种异质性部分可以通过 MRI 的性别分布、时间和解释的差异来解释，这表明 MRI 评估的 MSI 不仅受心脏保护治疗的影响，还受患者特征和 MRI 参数的影响。