超声心动图缺血记忆分子成像用于即时检测心肌缺血
Echocardiographic Ischemic Memory Molecular Imaging for Point-of-Care Detection of Myocardial Ischemia.
机构信息
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA.
出版信息
J Am Coll Cardiol. 2021 Nov 16;78(20):1990-2000. doi: 10.1016/j.jacc.2021.08.068.
BACKGROUND
Noninvasive molecular imaging of recent ischemia can potentially be used to diagnose acute coronary syndrome (ACS) with high accuracy.
OBJECTIVES
The authors hypothesized that bedside myocardial contrast echocardiography (MCE) ischemic memory imaging could be achieved with phosphatidylserine microbubbles (MB) that are retained in the microcirculation via ischemia-associated endothelial activation.
METHODS
A dose-finding study was performed in healthy volunteers (n = 17) to establish optimal MB dosing. Stable patients with ACS (n = 30) and confirmed antecedent but resolved myocardial ischemia were studied within 2 hours of coronary angiography and percutaneous coronary intervention (PCI) when indicated. MCE molecular imaging was performed 8 minutes after intravenous administration of MB MCE perfusion imaging was used to assess the status of the postischemic microcirculation.
RESULTS
Based on dose-finding studies, 0.10 or 0.15 mL of MB based on body mass was selected. In patients with ACS, all but 2 underwent primary PCI. MCE molecular imaging signal intensity was greater in the postischemic risk area vs remote territory (median [95% CI]: 56 [33-66] vs 8 [2-17] IU; P < 0.001) with a receiver-operating characteristic curve C-statistic of 0.94 to differentiate post-ischemic from remote territory. Molecular imaging signal in the risk area was not related to type of ACS (unstable angina: 3; non-ST-segment elevation myocardial infarction: 14; ST-segment elevation myocardial infarction: 13), peak troponin, time to PCI, post-PCI myocardial perfusion, GRACE (Global Registry of Acute Coronary Events) score, or HEART score.
CONCLUSIONS
Molecular imaging with point-of-care echocardiography and MB can detect recent but resolved myocardial ischemia. This bedside technique requires only minutes to perform and appears independent of the degree of ischemia. (Ischemic Memory Imaging With Myocardial Contrast Echocardiography; NCT03009266).
背景
最近的缺血性非侵入性分子成像有可能以高精度诊断急性冠状动脉综合征 (ACS)。
目的
作者假设通过与缺血相关的内皮激活而保留在微循环中的磷脂酰丝氨酸微泡 (MB) 可以实现床边心肌对比超声心动图 (MCE) 缺血记忆成像。
方法
在健康志愿者（n=17）中进行了剂量发现研究，以确定最佳 MB 剂量。在经皮冠状动脉介入治疗 (PCI) 时，在冠状动脉造影后 2 小时内对稳定型 ACS 患者（n=30）和已确认但已解决的心肌缺血患者进行研究。在静脉注射 MB 后 8 分钟进行 MCE 分子成像，以评估缺血后微循环的状态。
结果
基于剂量发现研究，选择了基于体重的 0.10 或 0.15 mL 的 MB。在 ACS 患者中，除 2 例外，所有患者均接受了直接 PCI。在缺血风险区域与远程区域相比，MCE 分子成像信号强度更大（中位数 [95%CI]：56 [33-66] 与 8 [2-17] IU；P<0.001），区分缺血后与远程区域的接受者操作特征曲线 C 统计量为 0.94。风险区域的分子成像信号与 ACS 类型无关（不稳定型心绞痛：3 例；非 ST 段抬高型心肌梗死：14 例；ST 段抬高型心肌梗死：13 例）、峰值肌钙蛋白、PCI 时间、PCI 后心肌灌注、GRACE（全球急性冠状动脉事件登记处）评分或 HEART 评分。
结论
利用即时护理超声心动图和 MB 进行分子成像可以检测到近期但已解决的心肌缺血。这种床边技术仅需几分钟即可完成，并且似乎与缺血程度无关。（心肌对比超声心动图的缺血记忆成像；NCT03009266）。
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