Mayr Agnes, Klug Gert, Reindl Martin, Lechner Ivan, Tiller Christina, Holzknecht Magdalena, Pamminger Mathias, Troger Felix, Schocke Michael, Bauer Axel, Reinstadler Sebastian J, Metzler Bernhard
University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
JACC Cardiovasc Imaging. 2022 Jun;15(6):1030-1042. doi: 10.1016/j.jcmg.2022.02.010. Epub 2022 May 11.
In patients with a first ST-segment elevation myocardial infarction (STEMI), the multi-annual evolution of myocardial tissue injury parameters, as assessed by cardiac magnetic resonance (CMR), has not yet been described.
This study examined myocardial tissue injury dynamics over a decade after STEMI.
Sequential CMR examinations (within the first week after STEMI, and at 4, 12, months, and 9 years thereafter) were conducted in 74 patients with STEMI treated with primary percutaneous coronary intervention. Left ventricular function, infarct size (IS), and microvascular obstruction (MVO) were assessed at all time points. T2∗, T2, and T1 mapping (n = 59) were added at 9-year scan to evaluate the presence of iron and edema within the infarct core, respectively.
IS decreased progressively and significantly between all CMR time points (all P < 0.001), with an average reduction rate of 5.8% per year (IQR: 3.5%-8.8%) and a relative reduction of 49% (IQR: 39%-76%) over a decade. MVO was present in 61% of patients at baseline, but was not present at the follow-up examinations. At 9-year CMR, 17 of 59 (29%) patients showed iron deposition within the infarct core, whereas 82% had persistent edema. Persistent iron and edema were associated with greater IS on any occasion (all P < 0.001), as well as the presence of MVO (P < 0.001). Patients with persistent iron and edema showed a lower relative regression of IS (P = 0.005 and P = 0.032, respectively) and greater end-systolic volumes over a decade (all P < 0.012 and P > 0.023, respectively). A T1 hypointense infarct core without evidence of T2∗ iron deposition (14 of 59 [24%] patients) was attributed to lipomatous metaplasia of the infarct.
The evolution of IS is a dynamic process that extends well beyond the first few months after STEMI. Persistence of iron and edema within the infarct core occurs up to a decade after STEMI and is associated with initial infarct severity and poor infarct healing.
在首次发生ST段抬高型心肌梗死（STEMI）的患者中，通过心脏磁共振成像（CMR）评估的心肌组织损伤参数多年来的演变情况尚未得到描述。
本研究调查STEMI后十年内心肌组织损伤的动态变化。
对74例行直接经皮冠状动脉介入治疗的STEMI患者进行序贯CMR检查（在STEMI后第一周内，以及此后4个月、12个月和9年）。在所有时间点评估左心室功能、梗死面积（IS）和微血管阻塞（MVO）情况。在9年扫描时增加T2∗、T2和T1成像（n = 59），分别评估梗死核心内铁和水肿的情况。
在所有CMR时间点之间，IS均呈逐渐且显著下降（所有P < 0.001），平均每年下降率为5.8%（四分位间距：3.5% - 8.8%），十年间相对下降49%（四分位间距：39% - 76%）。61%的患者在基线时存在MVO，但在随访检查时未再出现。在9年CMR检查时，59例患者中有17例（29%）梗死核心内有铁沉积，而82%有持续性水肿。持续性铁和水肿在任何情况下均与更大的IS相关（所有P < 0.001），也与MVO的存在相关（P < 0.001）。有持续性铁和水肿的患者在十年间IS的相对下降较小（分别为P = 0.005和P = 0.032），且收缩末期容积更大（所有P < 0.012和P > 0.023）。梗死核心T1信号减低且无T2∗铁沉积证据（59例患者中有14例[24%]）归因于梗死灶的脂肪化生。
IS的演变是一个动态过程，远远超出STEMI后的最初几个月。梗死核心内铁和水肿可持续至STEMI后十年，并与初始梗死严重程度和梗死愈合不良相关。
