Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany.
Eur J Radiol. 2023 Aug;165:110908. doi: 10.1016/j.ejrad.2023.110908. Epub 2023 Jun 7.
Patients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population.
Patients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers.
CMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable.
More than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.
急性缺血性脑卒中（AIS）患者存在发生不良心血管事件的高风险。到目前为止，该人群中心血管磁共振成像（CMR）衍生的心肌损伤负担尚未得到确定。
在一项前瞻性、单中心研究中，AIS 患者在发病后 120 小时内行 3T 磁共振检查。排除持续性心房颤动患者。采用稳态自由进动电影序列评估心脏双腔室和心房的形态和功能。基于心脏的原生和对比增强成像，包括钆布醇 0.15mmol/kg 后延迟强化（LGE）用于局灶性纤维化，以及 T2 和 T1 映射用于弥漫性病变，对心肌组织进行区分。应用特征追踪法检测心肌整体纵向应变（GLS）、周向应变（GCS）和径向应变（GRS）。采用高敏法检测心脏肌钙蛋白（99 百分位上界 14ng/L）。将 T2 映射值与 20 名健康志愿者进行比较。
在 115 例患者中，92 例（平均年龄 74 岁，40%为女性，已知心肌梗死 6%）成功完成了 CMR 增强检查。在 92 例患者中发现 31 例（34%）存在局灶性心肌纤维化（LGE），其中 23/31（74%）例为缺血性模式。与无 LGE 的患者相比，LGE 患者更有可能患有糖尿病、既往心肌梗死、既往缺血性脑卒中以及肌钙蛋白水平升高。LGE 的存在伴有弥漫性纤维化（原生 T1 值增加），即使在心脏的远程区域，也伴有整体径向、周向和纵向应变值降低。在所有 LGE 患者中，14/31（45%）例可检测到 T2 映射值增加。
超过三分之一的 AIS 患者在 CMR 上有局灶性心肌纤维化的证据。这些变化中近一半可能为急性或亚急性起病。这些发现伴有弥漫性心肌改变和心肌变形减少。需要进一步的研究，理想情况下在随访期间进行连续 CMR 测量，以确定这些发现对 AIS 后长期预后的影响。
