应用锰增强 MRI 评估顿抑心肌与存活心肌。
Assessment of stunned and viable myocardium using manganese-enhanced MRI.
机构信息
Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
出版信息
Open Heart. 2021 Jun;8(1). doi: 10.1136/openhrt-2021-001646.
OBJECTIVE
In a proof-of-concept study, to quantify myocardial viability in patients with acute myocardial infarction using manganese-enhanced MRI (MEMRI), a measure of intracellular calcium handling.
METHODS
Healthy volunteers (n=20) and patients with ST-elevation myocardial infarction (n=20) underwent late gadolinium enhancement (LGE) using gadobutrol and MEMRI using manganese dipyridoxyl diphosphate. Patients were scanned ≤7 days after reperfusion and rescanned after 3 months. Differential manganese uptake was described using a two-compartment model.
RESULTS
After manganese administration, healthy control and remote non-infarcted myocardium showed a sustained 25% reduction in T1 values (mean reductions, 288±34 and 281±12 ms). Infarcted myocardium demonstrated less T1 shortening than healthy control or remote myocardium (1157±74 vs 859±36 and 835±28 ms; both p<0.0001) with intermediate T1 values (1007±31 ms) in peri-infarct regions. Compared with LGE, MEMRI was more sensitive in detecting dysfunctional myocardium (dysfunctional fraction 40.5±11.9 vs 34.9%±13.9%; p=0.02) and tracked more closely with abnormal wall motion (r=0.72 vs 0.55; p<0.0001). Kinetic modelling showed reduced myocardial manganese influx between remote, peri-infarct and infarct regions, enabling absolute discrimination of infarcted myocardium. After 3 months, manganese uptake increased in peri-infarct regions (16.5±3.5 vs 22.8±3.5 mL/100 g/min, p<0.0001), but not the remote (23.3±2.8 vs 23.0±3.2 mL/100 g/min, p=0.8) or infarcted (11.5±3.7 vs 14.0±1.2 mL/100 g/min, p>0.1) myocardium.
CONCLUSIONS
Through visualisation of intracellular calcium handling, MEMRI accurately differentiates infarcted, stunned and viable myocardium, and correlates with myocardial dysfunction better than LGE. MEMRI holds major promise in directly assessing myocardial viability, function and calcium handling across a range of cardiac diseases.
TRIAL REGISTRATION NUMBERS
NCT03607669; EudraCT number 2016-003782-25.
目的
在一项概念验证研究中，使用锰增强 MRI（MEMRI）来定量检测急性心肌梗死患者的存活心肌，这是一种评估细胞内钙处理的方法。
方法
健康志愿者（n=20）和 ST 段抬高型心肌梗死患者（n=20）接受钆布醇延迟增强（LGE）和锰二吡咯二磷酸（Mn-DPDP）的 MEMRI。患者在再灌注后≤7 天进行扫描，并在 3 个月后再次扫描。使用双室模型描述差异锰摄取。
结果
给予锰后，健康对照组和远隔非梗死心肌的 T1 值持续降低 25%（平均降低 288±34 和 281±12 毫秒）。梗死心肌的 T1 缩短程度低于健康对照组或远隔心肌（1157±74 比 859±36 和 835±28 毫秒；均 p<0.0001），梗死周边区域的 T1 值为中间值（1007±31 毫秒）。与 LGE 相比，MEMRI 在检测功能障碍心肌方面更敏感（功能障碍分数为 40.5±11.9%比 34.9%±13.9%；p=0.02），与异常壁运动的相关性也更高（r=0.72 比 0.55；p<0.0001）。动力学模型显示，远隔、梗死周边和梗死区的心肌锰内流减少，从而能够对梗死心肌进行绝对区分。3 个月后，梗死周边区的锰摄取增加（16.5±3.5 比 22.8±3.5 mL/100 g/min，p<0.0001），但远隔区（23.3±2.8 比 23.0±3.2 mL/100 g/min，p=0.8）或梗死区（11.5±3.7 比 14.0±1.2 mL/100 g/min，p>0.1）的心肌则没有变化。
结论
通过可视化细胞内钙处理，MEMRI 可以准确区分梗死、顿抑和存活心肌，并与 LGE 相比更好地与心肌功能障碍相关。MEMRI 在直接评估各种心脏疾病的存活心肌、功能和钙处理方面具有很大的潜力。
试验注册号
NCT03607669；EudraCT 编号 2016-003782-25。
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