Díaz-Navarro Rienzi, Silva González Danilo, Henríquez-Roldán Carlos
Departamento de Medicina Interna, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile.
Unidad de Cuidados Intensivos, Clínica Bupa Reñaca, Viña del Mar, Chile.
Rev Med Chil. 2020 Oct;148(10):1406-1417. doi: 10.4067/S0034-98872020001001406.
Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it.
To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs.
We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded.
Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE.
Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.
疑似ST段抬高型心肌梗死（STEMI）住院患者，其侵入性冠状动脉造影（ICA）显示冠状动脉（CA）正常，可能患有急性心肌梗死（AMI）或其他类似疾病的急性心脏疾病。
评估心脏磁共振成像（CMRI）对诊断冠状动脉正常但类似AMI疾病的有效性。
我们研究了424例因疑似STEMI入院并接受ICA的连续患者。冠状动脉正常者接受CMRI检查，包括电影CMRI序列以评估节段性室壁运动、T2加权短反转时间反转恢复成像以检测水肿以及钆剂注射后的延迟对比增强（DCE）以识别坏死/纤维化。排除既往有心肌梗死的患者。
26例患者（6.1%）冠状动脉正常。CMRI检查后确诊为急性心肌炎的患者有11例（42.3%），其DCE位于心外膜下或心肌内而非心内膜；确诊为AMI的患者有9例（34.6%），其DCE为心内膜下或透壁性；确诊为Takotsubo心肌病（TCM）的患者有6例（23.1%），其CMRI显示左心室局部收缩功能异常和心肌水肿但无DCE。
心脏磁共振成像可对冠状动脉造影正常的患者准确诊断急性心肌梗死。
