CMR T2* 序列测量的 STEMI 患者心肌内出血的预后价值和临床预测因素。

Prognostic value and clinical predictors of intramyocardial hemorrhage measured by CMR T2* sequences in STEMI.

机构信息

Department of Cardiology, Hospital Universitari I Politècnic La Fe, Valencia, Spain.

Hospital Universitari Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Tarragona, Spain.

出版信息

Int J Cardiovasc Imaging. 2021 May;37(5):1735-1744. doi: 10.1007/s10554-020-02142-7. Epub 2021 Jan 13.

Abstract

Recent studies show that microvascular injury consists of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). In patients with reperfused ST-segment elevation myocardial infarction (STEMI) quantitative assessment of IMH with T2* cardiovascular magnetic resonance imaging (CMR) appears to be useful in evaluation of microvascular damage. The current study aimed to investigate feasibility of this approach and to correlate IMH with clinical and CMR parameters. A single center observational cohort study was performed in reperfused STEMI patients with CMR examination 7 days (IQR: 5 to 8 days) after percutaneous coronary intervention. Infarct size (IS) and MVO were evaluated in short-axis late gadolinium enhancement sequences and IMH with whole LV volume T2* mapping sequences. Of the 94 patients, MVO was identified in 52% of patients and the median size of MVO was 3% of LV mass (IQR: 1.5 to 5.4%). IMH was present in 28% of patients and the median size of IMH was 1.1% of LV mass (IQR: 0.5 to 2.9%). IMH extent was independently associated with anterior myocardial infarction (p = 0.022) and thrombectomy (p = 0.049). IMH was correlated with MVO (R = 0.62, p < 0.001), necrosis (R = 0.58, p < 0.001) and LVEF (R = -0.21, p = 0.04). Patients with IMH presented higher incidence of MACE events, independently of LVEF (p = 0.022). T2* mapping is a novel imaging approach that proves useful to asses IMH in the setting of reperfused STEMI. T2* IMH extent was associated with anterior infarction and thrombectomy. T2* IMH was associated with higher incidence of MACE events regardless preserved or reduced LVEF.

摘要

近期研究表明微血管损伤包括微血管阻塞(MVO)和心肌内出血(IMH)。在接受再灌注治疗的 ST 段抬高型心肌梗死(STEMI)患者中,使用 T2心血管磁共振成像(CMR)定量评估 IMH 似乎有助于评估微血管损伤。本研究旨在探讨这种方法的可行性,并将 IMH 与临床和 CMR 参数相关联。在接受经皮冠状动脉介入治疗后 7 天(IQR:5-8 天)的再灌注 STEMI 患者中进行了一项单中心观察性队列研究。在短轴晚期钆增强序列中评估梗死面积(IS)和 MVO,并在整个 LV 容积 T2映射序列中评估 IMH。在 94 例患者中,52%的患者存在 MVO,MVO 的中位数大小为 LV 质量的 3%(IQR:1.5-5.4%)。28%的患者存在 IMH,IMH 的中位数大小为 LV 质量的 1.1%(IQR:0.5-2.9%)。IMH 程度与前壁心肌梗死(p=0.022)和血栓切除术(p=0.049)独立相关。IMH 与 MVO(R=0.62,p<0.001)、坏死(R=0.58,p<0.001)和 LVEF(R=-0.21,p=0.04)呈正相关。无论 LVEF 如何,存在 IMH 的患者发生 MACE 事件的发生率更高(p=0.022)。T2* 映射是一种新的成像方法,可用于评估再灌注治疗的 STEMI 中的 IMH。T2* IMH 程度与前壁梗死和血栓切除术相关。T2* IMH 与 MACE 事件的发生率较高相关,无论 LVEF 是否保留或降低。

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