使用四维血流心脏磁共振成像量化心肌血流和阻力。

Quantifying Myocardial Blood Flow and Resistance Using 4D-Flow Cardiac Magnetic Resonance Imaging.

作者信息

Gosling Rebecca C, Williams Gareth, Al Baraikan Abdulaziz, Alabed Samer, Levelt Eylem, Chowdhary Amrit, Swoboda Peter P, Halliday Ian, Hose D Rodney, Gunn Julian P, Greenwood John P, Plein Sven, Swift Andrew J, Wild James M, Garg Pankaj, Morris Paul D

机构信息

Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.

Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

出版信息

Cardiol Res Pract. 2023 Feb 2;2023:3875924. doi: 10.1155/2023/3875924. eCollection 2023.

DOI:10.1155/2023/3875924

PMID:36776959

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9911256/

Abstract

BACKGROUND

Ischaemia with nonobstructive coronary arteries is most commonly caused by coronary microvascular dysfunction but remains difficult to diagnose without invasive testing. Myocardial blood flow (MBF) can be quantified noninvasively on stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography but neither is routinely used in clinical practice due to practical and technical constraints. Quantification of coronary sinus (CS) flow may represent a simpler method for CMR MBF quantification. 4D flow CMR offers comprehensive intracardiac and transvalvular flow quantification. However, it is feasibility to quantify MBF remains unknown.

METHODS

Patients with acute myocardial infarction (MI) and healthy volunteers underwent CMR. The CS contours were traced from the 2-chamber view. A reformatted phase contrast plane was generated through the CS, and flow was quantified using 4D flow CMR over the cardiac cycle and normalised for myocardial mass. MBF and resistance (MyoR) was determined in ten healthy volunteers, ten patients with myocardial infarction (MI) without microvascular obstruction (MVO), and ten with known MVO.

RESULTS

MBF was quantified in all 30 subjects. MBF was highest in healthy controls (123.8 ± 48.4 mL/min), significantly lower in those with MI (85.7 ± 30.5 mL/min), and even lower in those with MI and MVO (67.9 ± 29.2 mL/min/) ( < 0.01 for both differences). Compared with healthy controls, MyoR was higher in those with MI and even higher in those with MI and MVO (0.79 (±0.35) versus 1.10 (±0.50) versus 1.50 (±0.69), =0.02).

CONCLUSIONS

MBF and MyoR can be quantified from 4D flow CMR. Resting MBF was reduced in patients with MI and MVO.

摘要

背景

非阻塞性冠状动脉缺血最常见的原因是冠状动脉微血管功能障碍，但在没有侵入性检查的情况下仍难以诊断。心肌血流（MBF）可通过应力灌注心脏磁共振成像（CMR）或正电子发射断层扫描进行无创定量，但由于实际和技术限制，这两种方法在临床实践中均未常规使用。冠状窦（CS）血流定量可能是一种更简单的CMR心肌血流定量方法。四维血流CMR可提供全面的心腔内和跨瓣膜血流定量。然而，其定量心肌血流的可行性尚不清楚。

方法

急性心肌梗死（MI）患者和健康志愿者接受CMR检查。在两腔视图中描绘冠状窦轮廓。通过冠状窦生成一个重新格式化的相位对比平面，并使用四维血流CMR在心动周期内对血流进行定量，并根据心肌质量进行标准化。在10名健康志愿者、10名无微血管阻塞（MVO）的心肌梗死（MI）患者和10名已知MVO的患者中测定心肌血流和阻力（MyoR）。

结果

所有30名受试者均成功定量心肌血流。健康对照组的心肌血流最高（123.8±48.4 mL/min），心肌梗死患者显著降低（85.7±30.5 mL/min），心肌梗死合并MVO患者更低（67.9±29.2 mL/min/）（两组差异均<0.01）。与健康对照组相比，心肌梗死患者的心肌阻力更高，心肌梗死合并MVO患者更高（0.79（±0.35）对1.10（±0.50）对1.50（±0.69），P=0.02）。