Calvieri Camilla, Riva Alessandra, Sturla Francesco, Dominici Lorenzo, Conia Luca, Gaudio Carlo, Miraldi Fabio, Secchi Francesco, Galea Nicola
Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy.
Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy.
J Clin Med. 2023 Jan 1;12(1):334. doi: 10.3390/jcm12010334.
Post-ischemic left ventricular (LV) remodeling is a biologically complex process involving myocardial structure, LV shape, and function, beginning early after myocardial infarction (MI) and lasting until 1 year. Adverse remodeling is a post-MI maladaptive process that has been associated with long-term poor clinical outcomes. Cardiac Magnetic Resonance (CMR) is the best tool to define adverse remodeling because of its ability to accurately measure LV end-diastolic and end-systolic volumes and their variation over time and to characterize the underlying myocardial changes. Therefore, CMR is the gold standard method to assess in vivo myocardial infarction extension and to detect the presence of microvascular obstruction and intramyocardial hemorrhage, both associated with adverse remodeling. In recent times, new CMR quantitative biomarkers emerged as predictive of post-ischemic adverse remodeling, such as T1 mapping, myocardial strain, and 4D flow. Additionally, CMR T1 mapping imaging may depict infarcted tissue and assess diffuse myocardial fibrosis by using surrogate markers such as extracellular volume fraction, which may predict functional recovery or risk stratification of remodeling. Finally, there is emerging evidence supporting the utility of intracavitary blood flow kinetic energy and hemodynamic features assessed by the 4D flow CMR technique as early predictors of remodeling.
缺血后左心室（LV）重构是一个生物学上复杂的过程，涉及心肌结构、左心室形状和功能，始于心肌梗死（MI）后早期并持续至1年。不良重构是心肌梗死后的一种适应性不良过程，与长期不良临床结局相关。心脏磁共振成像（CMR）是定义不良重构的最佳工具，因为它能够准确测量左心室舒张末期和收缩末期容积及其随时间的变化，并能够描述潜在的心肌变化。因此，CMR是评估体内心肌梗死范围以及检测微血管阻塞和心肌内出血（两者均与不良重构相关）的金标准方法。近年来，新的CMR定量生物标志物已成为缺血后不良重构的预测指标，如T1 mapping、心肌应变和四维血流。此外，CMR T1 mapping成像可通过使用细胞外容积分数等替代标志物描绘梗死组织并评估弥漫性心肌纤维化，这些标志物可预测功能恢复或重构的风险分层。最后，越来越多的证据支持通过四维血流CMR技术评估的心腔内血流动能和血流动力学特征作为重构早期预测指标的实用性。
